Arizona Foster Care Lawsuit John Doe Notice of Claim 2018-01-31

CADIGAN LAW FIRM, PLLC
A Professional Limited Liability Company

Attorney at Law
Lynne M. Cadigan
lmcadigan@gmail.com
520-405-7168
520-622-6066
January 31, 2018
NOTICE OF CLAIM UNDER A.R.S. §. 12-821.01
SERVED BY PRIVATE PROCESS SERVER & SENT BY CERTIFIED MAIL
Mark Brnovich
Attorney General
State of Arizona
2005 N. Central Ave
Phoenix, AZ 85004
Gregory McKay
Director
Arizona Department of Child Safety (DCS)
3003 N. Central Avenue
Phoenix, AZ 85012
Michael Trailor
Director
Arizona Department of Economic Security (DES)
1624 W. Adams St.
Phoenix, AZ 85007
Deb Nishikida
Director, Sierra Vista Office
2981 E Tacoma St
Sierra Vista, AZ 85635
Noemi Ochoa
Licensing Worker
2981 E Tacoma St
504 South Stone Avenue, Tucson, Arizona 85701

Telephone: (520) 622-6066
James Robinson
Manager
Arizona Department of Economic Security
2981 E Tacoma St
State of Arizona Employees/DCS/CPS including the following:
Christine McGuire
Norma Lewis
Veronica Castillo
Kirk Stevens
Christina Delgado
Candice Winters
Kaila Kerley
Jessica Blackburn
Linda Tucker Church
George Stevens
Jane and John Does 1-15

Employees of CPS/DCS
State of Arizona
Re: Notice of Claim by John Doe1
Dear Sirs/Madams:
This letter serves as John Doe’s Notice of Claim pursuant to A.R.S. § 12-821.01 against the State
of Arizona, Child Protective Services (“CPS”), now called DCS, the Arizona Department of Child
Safety and Family Services (“DCS”), the Arizona Department of Economic Security (DES), and
the individual DCS caseworkers listed above and those whose names are not known at this time.
This letter is subject to Ariz. R. Evidence, 408.
The facts, supporting documents, case law, the nature of John Doe’s damages’ and the
specific amount for which the claim can be settled are set forth below.
I. FACTS PROVIDING BASIS FOR CLAIMS
The State of Arizona has for years been fully aware of the inadequate safety measures of
Child Protective Services and, later, its successor, the Department of Child Safety. Children taken
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Counsel believes that the parties served with this Notice of Claim are aware of the true identity
of John Doe. Counsel are not providing John Doe’s true name for the sake of his privacy. If the
parties are uncertain of Mr. Doe’s identity please contact us and we will provide that information
under separate cover.
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from problem homes are the most vulnerable children in the State. These children, like John Doe,
after suffering trauma and abuse in their own home, are taken into the legal custody of the State,
ostensibly to protect them from further abuse. However, these children then suffer even more abuse
once in the “care” of the State. (Exhibit A - class action lawsuit against DCS) Former Arizona
Governor Jan Brewer, admitted publicly in 2014 “that the Arizona’s child welfare system is
broken, impeded by years of structural and operational failures.” (Exhibit B - news article) The
failure of the State to protect the children in their care has been well documented in the reports
commissioned by the State. (Exhibit C – Report “In Harms Way”)
John Doe is a victim of the State of Arizona’s failed child protection practices and policies.
John Doe, who is now 18 years old, suffered over 12 years of shocking physical and sexual abuse
because of the State’s refusal to protect him. John Doe was born in September of 1999 and before
his fourth birthday was placed in foster care. The Frodshams were approved by the State to have
John Doe in their home in 2004 and John Doe was subsequently adopted by David and Barbara
Frodsham in 2012. The Frodshams were licensed foster parents with the State of Arizona from
2002 to January 2015. The Frodsham license was not suspended until David Frodsham was
arrested at the DES office for felony drunk driving with toddlers in the vehicle. (Exhibit D – David
Frodsham DUI indictment). The State and its employees ignored actual notice of the abuse of John
Doe and numerous warning signs that the Frodsham home was dangerous.
The State did not remove John Doe until ICE, a federal agency within the Department of
Homeland Security, arrested David Frodsham for operating a pornographic pedophile ring based
in the home. ICE identified John Doe as a victim of Frodsham’s pedophilia. John Doe suffered
sexual, physical and emotional abuse for over 12 years in this home, despite numerous red flags
of abuse and neglect. This abuse was no secret to CPS/DCS and well documented yet no
investigations were undertaken (Exhibit E – DCS records of abuse). The CPS/DCS employees
listed above are the ones who are known by us at this time, as the records of DCS and CPS as well
as the licensing agencies have not been released, despite requests. Suffice it to say, however, the
agencies can readily identify these individuals. Additional facts and employees will be added once
John Doe’s files are released to him.
David Frodsham was convicted and sentenced to 17 years in prison in December of 2016
for child sexual abuse and pornography, with John Doe as one of the victims. (Exhibit F – David
Frodsham plea agreement and sentencing order) David Frodsham utilized the State of Arizona and
the foster care system to funnel innocent, vulnerable children into his home, so he could run a
pedophile ring. John Doe was sexually and physically abused by David Frodsham countless times
both inside and outside the home while Frodsham’s wife, Barbara witnessed this abuse, and
physically abused John Doe herself. Mr. Frodsham also acted as John Doe’s pimp, prostituting
John Doe to other men, for their sexual enjoyment, and for money for himself., Frodsham often
participated in these sexual meetups. Frodsham helped enable a network of pedophiles in the Sierra
Vista area and these men participated in further sexual abuse against John Doe. (Exhibit G and H
- indictments of Randall Bischak and Anthony Savage)
Barbara Frodsham neglected John Doe terribly, and physically and emotionally abused him
as well. Barbara knew the sexual abuse was occurring, at times walking in the room as it was
happening, yet took no steps to stop it. Mrs. Frodsham routinely beat John Doe and blamed him
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for the abuse heaped on him. Barbara did not buy John Doe clothes or feed him, and screamed at
him every time he tried to complain or protect himself, often beating him viciously. It was obvious
to all, including the State DCS employees that Barbara Frodsham hated John Doe. The Frodshams
forced John Doe to live outside much of the time. While they went to work they locked John Doe
out of their home and left him with a bike to travel to a convenience store to use the restroom. This
neglect and abuse was documented by the State and its employees. The foster and other children,
including John Doe, were forced to eat hot sauce as punishment, handcuffed to the bed all night,
locked outside the home, and locked in closets. John Doe and the other boys were beaten with
fists, brooms, belts and other objects to the extent that medical care was frequently required.
CPS/DCS did not investigate this physical abuse. It was openly noted in DCS records that Barbara
had a different demeanor and attitude toward the boys in the home as opposed to the girls. Barbara
was “jealous” of the sexual attention the boys received from her husband, and punished them for
it. (Exhibit E - DCS records documenting abuse)
CPS/DCS just turned a blind eye, and the abuse continued unabated. Barbara Frodsham
kept up a steady stream of complaints about John Doe to everyone, including DCS, and made him
the scapegoat for any and all problems. The State simply put John Doe on medication, which was
not necessary and harmed him even more. The State and its employees wrongfully medicated
John Doe, ignored his complaints and essentially paid the Frodshams to continue the abuse. John
Doe’s problems should have triggered action by the State to help John Doe. When a child acts out
so frequently, and is truant, on medication, getting “special help” to overcome anger and acting
out, that is a glaring red flag something is wrong in the home.
The State had access to over thirty-eight police reports from the Frodsham household, from
2002 to early 2016, (all prior to the arrest of David Frodsham for sex abuse) The State should have
reviewed these as part of their licensing process of the foster/adoptive parent program. John Doe
complained to CPS/DPS over sixteen times and nothing was done. Even more shocking, there
were at least 10 abuse and neglect complaints documented by CPS/DCS between 2002 to 2015.
Children in abusive homes rarely can report the abuse, as if they do they are beaten again. This is
exactly what happened to John Doe, he would complain to CPS or call the police, and what would
result was a beating from Barbara and/or David. This is exactly why CPS/DCS should have
intervened, examined John Doe’s injuries, and taken John Doe to a place where he would not be
afraid of retaliation by his abusers. John Doe was completely vulnerable to the manipulation and
neglect of Barbara and David Frodsham, and helpless to protect himself from their physical,
emotional and sexual abuse.
It was not just the police reports, DCS documentation of abusive parenting, neglect,
constant complaints, and acting out that should have triggered the State to remove John Doe. There
was additional information about David Frodsham that indicated he was an unsuitable foster
parent, much less an adoptive parent. David Frodsham was assigned as a deputy commander with
the Department of Defense in Afghanistan. He only served for a brief period, as he was kicked
out and released from duty, and told he could not return because of his “sexual harassment”
behavior and an assessment by the military that he had an unalterable personality disorder. For a
deputy commander to be removed from duty in Afghanistan and told never to return for service is
glaring evidence that David had negative personality qualities which could easily make him an
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unfit parent. The military investigated his behavior and upheld the inappropriate sexual behavior
findings. The investigator stated,
“I recommend the unit keep Mr. Frodsham resigned out of BSG

permanently. Bringing him back to the unit will only cause further tensions. The
ability of Mr. Frodsham to be rehabilitated is completely up to him. I believe this
inappropriate conduct has been part of Mr. Frodsham’s personality for some time.
The Army has articulated its zero-tolerance policy. I am convinced that Mr.
Frodsham is aware of what constitutes sexual harassment, because he previously
held a position in Equal Opportunity, as he stated in his interview. Still he chose to
violate said policy
I recommend making this misconduct a official matter of record and take

disciplinary action under Chapter 75 of Title 5/AFI 36-704 Discipline and Adverse
Actions. I recommend the command administratively punish Mr. Frodsham with
reprimand and refer member to home unit.”
A review of these records by a psychologist who does assessments of sex offenders in the
military believes that the coded language of the discharge indicates the underlying reason for his
removal was sexual abuse of boys in Afghanistan. It is well documented that in Afghanistan,
abuse of young boys is a serious problem for the U.S. military. (Exhibit H - news article re military
and abuse)
Sierra Vista is a small “one company” town. David Frodsham let everyone know he had
an important position in the military. Everyone knew he was a heavy drinker who was aggressive,
loud, and belligerent. Frodsham bullied everyone into believing that because he was employed by
the military with a high ranking and top security clearance, he could do whatever he pleased.
Although he was deemed unfit to serve in Afghanistan, a war zone, due to sexual misbehavior and
personality disorders, was constantly having domestic disturbances in the home, police reports on
his children and family, in addition to other foster children running away and accusing him of
abuse, DCS deemed the Frodsham fit parents, licensed them, and allowed this family to profit
financially by physically and sexually abusing children for over 12 years.
According to federal and State prosecutors, more cases are expected to be filed involving
the pedophile ring operated by David Frodsham. ICE seized videos made by David Frodsham of
a 4-year-old girl being penetrated and screaming for her “mommy”. This victim could be one of
the children in the Frodsham home. The biological mother of a 4-year-old girl had her child placed
in the Frodsham home and complained to the State that her little girl was suffering from severe
urinary tract infections because she was being sexually abused. The State’s response was to accuse
this mother of making false allegations. No investigation of the Frodshams was done based on
this mother’s allegations. Frodsham’s presentence report details that David Frodsham was talking
with another pedophile about how 4-year-olds are “tasty”.
If the Frodshams were the biological parents of John Doe, he would have been removed
based on these complaints and allegations, and placed in a group home. Instead, the State left John
Doe in the foster/adoptive home, and the Frodshams received a monthly stipend from the State to
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abuse him. The State ignores abuse in foster and adoptive homes, yet immediately removes
children from biological parents for much lesser reasons. This policy and practice resulted in
unchecked abuse and permanent harm to children, including John Doe.
The State of Arizona and the CPS caseworkers listed above (and others yet to be identified) failed
to prevent the abuse of John Doe by the following pattern and practices and omissions and actions:
- Failing to properly investigate and supervise the placement of John Doe in the foster and
adoptive home.
- Failing to provide and follow proper policies to protect John Doe, including investigating,
supervising, and evaluating John Doe’s complaints, the reports of abuse to DCS, and the
domestic violence situations at the home.
- Failing to listen to and investigate the warnings about the dangers in the home.
- Failure to heed the warnings of the biological mother of a foster child in the home about
sexual abuse of her own child in the household.
- Failure to take notice of the numerous police reports, the drunken behavior of David
Frodsham, the expulsion of David Frodsham for sexual harassment from his military
posting, the constant problems and complaints coming from the home.
- Failure to take action on their admitted knowledge of the obvious abuse of chaining John
Doe to the bed all night, yet allowing the adoption to go through.
- The named actors and the State of Arizona were grossly negligent and deliberately
indifferent in their negligent policies and improper implementation of their policies by a
widespread failure to conduct investigations of reports that children have been maltreated
while in State foster care custody, a severe shortage of family foster homes, and a
widespread failure to engage in basic child welfare practices.
- The State of Arizona had a pattern and practice of ignoring abuse and neglect of the
children in their care, and a pattern and practice of failing to properly investigate and
license foster and adoptive homes.
- The failure of the State of Arizona in licensing the Frodshams as foster and adoptive
parents, and failing to revoke their license despite being notified and having access to abuse
and neglect allegations from all sources. This includes the failure of the State to properly
review the process the licensing agencies use to investigate families, and failure to be
involved in the licensing of foster and adoptive parents.
- There were numerous deliberate and negligent failings of the State in this case, as despite
constant DCS presence and reports and complaints, the Frodshams were allowed to traffic
their children for sex and pornography, abuse and beat the children in horrific ways, and
yet blame it all on the children. The State assumed care and supervision of this foster and
adoptive home, and did nothing to protect the innocent children they placed in harm’s way.
The standard to remove the children is the same for foster and adoptive children as
biological children, yet the State failed to implement these safeguards. Once the children
were removed, the foster and adoptive homes were not monitored, investigated or
supervised for abuse
The State’s refusal to protect John Doe resulted in him suffering years of horrific sexual,
physical, and emotional abuse. John Doe has physical scars from the abuse, but the emotional
damage he has suffered, and will continue to suffer is permanent and devastating. As a child John
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Doe would self-mutilate, act out, and contemplate suicide in order to escape the traumas he
endured. John Doe had no love or care during his childhood, was shackled, beaten, thrown outside
to forage, sexually abused, sold as a sex toy, and yet was told he was the one to blame for his own
abuse. This torture for the duration of his childhood is difficult to even imagine. John Doe cannot
yet escape these nightmares, as John Doe is the named victim in many additional criminal cases.
This means John Doe will have to testify against his perpetrators and be identified and relive those
horrendous experiences; he will never be able to escape. Every time ICE obtains new pornographic
videos that involve John Doe, he has to be notified. The fact that these images are out there forever
creates emotional damage that is beyond measure. John Doe struggles with leaving the house as
he feels that others know about the crimes enacted against him or, even worse, that there are more
predators waiting to abuse him or get rid of him as a witness. Most of the predators are in the
military in Sierra Vista with top secret security clearances. John Doe reasonably believes they
have the ability to escape retribution and could harm him. John Doe understandably has no faith
in any institution or government agency, as it was the government entities which ignored his pleas
for help, facilitated his abuse, and called him a liar. Nothing can ever repair the physical and
emotional damage that John Doe suffered. John Doe is deprived of any modality of treatment to
heal his emotional wounds, as John Doe has no faith in therapeutic treatment, as all of the State’s
institutions failed him.
Because of the gross negligence and deliberate indifference to the welfare of John Doe, he suffered
horrific, sexual abuse, physical abuse and permanent and severe emotional injuries. David
Frodsham has been sentenced to almost two decades of prison for this abuse of John Doe, but John
Doe will suffer a lifetime of mental anguish. John Doe has already endured 12 years of abuse as
a prisoner in the Frodsham home, and will have to live the rest of his adult life reliving these
memories of abuse. John Doe will never escape this legacy of abuse he suffered as a result of the
State’s negligence and deliberate indifference to his plight.
II. LAW SUPPORTING CLAIMS
The Defendants are liable under numerous State and federal law claims, including, Negligence,
Intentional Infliction of Emotional Distress, Gross Negligence, Negligence Per Se, Breach of
Fiduciary Duty, Negligent Failure to enact proper policies and procedures to protect foster and
adoptive children, and breach of numerous existing State statutes and regulations designed to
protect John Doe. The State and its employees violated John Doe’s constitutional rights to privacy,
liberty interests, due process, and the right to be free from abuse, neglect and child sex trafficking.
The actions of the State, DES/CPS, and other individuals were grossly negligent and done with
deliberate indifference to the safety of the children entrusted in their care. The State, DES/CPS,
employees above and individuals to be named, knew that there was a statewide failure to comply
with safety standards, and that investigation and supervision of foster and adopting families were
being addressed in a negligent and sub-standard manner. The State ignored the evidence in front
of it, ignored the red flags, violated the basic duties of training, supervision, and investigation of
the foster homes and adoptive parents, all of which harmed John Doe, a helpless, vulnerable child.
The State, DCS/CPS and various caseworkers and supervisors had the obligation and fiduciary
duty to protect John Doe when they placed him in the Frodsham home. There were obvious signs
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and warnings that the Frodsham home was not safe, and the CPS/DCS workers were fully aware
of these problems yet chose to ignore them. John Doe’s constitutional rights (indeed, basic human
rights) to reasonable safety and freedom from harm were violated while in the care of the State.
John Doe’s due process rights were violated by the State’s failure to follow its own statutory and
mandated rules and regulations to investigate the allegations of neglect and abuse, the failure of
the State to promulgate proper rules and regulations to protect children, and by the failure of the
State to follow properly license, or to refuse to license or revoke the license of the Frodshams as
foster and adoptive parents. A social worker’s failure to exercise professional judgment in the
placement and monitoring of a child in State care subjects the worker to individual liability under
42 U.S.C. § 1983. Weatherford v. State of Arizona, 81 P.3d 320, 206 Ariz. 529 (2003).
Titles 8 and 36 of the Arizona statutes set out the licensing and care requirements that the State
failed to follow. Also, the Arizona Administrative Code sets out the standard of care for the
investigation, licensing, monitoring, supervision and placement of children in their care, and the
State failed to comply with these mandated rules. As a result of this failure to comply with even
the basic standards of care set out in statute and regulation, John Doe and many others have
suffered severe injury. The regulations themselves did not provide a safe framework to protect the
children. The State’s own policies and practices were negligent and deliberately indifferent to the
welfare of the children in their care, including John Doe. The State employees listed above (and
likely others who will be identified) knew or should have known that John Doe should have been
removed, and knew or should have known the home was dangerous and damaging John Doe. The
State, DES, and DCS by the acts of their employees neglected to perform their required duties.
The actions of DES, DCS and the State and the employees of the State listed above were grossly
negligent and caused severe and permanent damage to John Doe. John Doe is entitled to damages
for emotional distress, physical injury, future damages, attorney fees, and punitive damages both
under State common law and 42 U.S.C. §1983 against the above the above-named entities and all
of the named individuals.
The State is still liable for the acts of the Frodshams after John Doe was adopted, as they were still
receiving calls about his behavior and complaints from John Doe, and supposedly investigating
these matters after the adoption. The State has a duty to protect any child that is the subject of
abuse or neglect complaints or suspicions. The State created the danger of abuse and molestation
that John Doe would not have faced had the State adequately protected him as a result of the
repeated complaints and problems that they were aware of prior to the adoption, while he was still
a foster child. The State is still liable for the abuse John Doe suffered after the adoption. Tamas v
Department of Social & Health Services, 630 F.3d 833 (2010 9th Cir)
III. SPECIFIC AMOUNT FOR WHICH JOHN DOEWILL SETTLE HIS CLAIM.
John Doe wants to change the way the DCS operates, he wants to send a message to the State of
Arizona to protect the children in their care. John Doe is willing to resolve his claims against The
State of Arizona, DCS, Arizona Department of Economic Security of Children, Youth Families,
and the individual DCS caseworkers named and those whose names are not known at this time for
the following amount, $15,000,000. John Doe’s childhood was destroyed. John Doe suffered years
of torture, and his future life will be forever marred by the abuse he suffered, and the ongoing
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criminal cases he will have to endure as a victim/witness. Arizona must change and do something
to protect its children. These stories of abuse are all too familiar here in Arizona.
Sincerely,
Lynne M. Cadigan
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EXHIBIT A
Class action lawsuit against

Arizona DCS
Case 2:15-cv-00185-ROS Document 37 Filed 06/08/15 Page 1 of 53
1 Joseph Mais (005470) William Kapell (admitted pro hac vice)

Shane Swindle (011738) Julia L. Davis (admitted pro hac vice)
2 P ERKINS COIE LLP Rachel B. Nili (admitted pro hac vice)
2901 N. Central Avenue, Suite 2000 Adriana T. Luciano (admitted pro hac
3
Phoenix, Arizona 85012-2788 vice)
4 T: (602) 351-8000 CHILDREN’S RIGHTS, INC.
F: (602) 648-7000 330 Seventh Avenue, Fourth Floor
5 jmais@perkinscoie.com
New York, New York 10001
sswindle@perkinscoie.com
6 T: (212) 683-2210
F: (212) 683-4015
7 Anne C. Ronan (006041)
wkapell@childrensrights.org
Timothy M. Hogan (004567)
8 jdavis@childrensrights.org
ARIZONA CENTER FOR LAW IN THE rnili@childrensrights.org
P UBLIC INTEREST aluciano@childrensrighs.org
9
514 West Roosevelt Street
10 Phoenix, Arizona 85003
T: (602) 258-8850
11 F: (602) 258-8757
12 aronan@aclpi.org
thogan@aclpi.org
13
14 Attorneys for Plaintiffs
UNITED STATES DISTRICT COURT
15
DISTRICT OF ARIZONA
16
B.K. by her next friend Margaret Tinsley; ) No. 2:15-cv-00185-PHX-ROS
17 C.P. and B.T. by their next friend Jennifer )
Kupiszewski; A.T.; A.C-B; M.C-B; J.C-B; )
18 D.C-B; J.M. and J.C. by their next friend ) SECOND AMENDED COMPLAINT
Susan Brandt, for themselves and those ) FOR INJUNCTIVE AND
19 similarly situated, ) DECLARATORY RELIEF AND
20 Plaintiffs, ) REQUEST FOR CLASS ACTION
v. )
21 )
Gregory McKay, in his official capacity as ) (Assigned to the Honorable Roslyn
22 Director of the Arizona Department of Child ) O. Silver)
Safety; Cara M. Christ, in her official capacity )
23 as Director of the Arizona Department of )
Health Services; and Thomas J. Betlach, in his )
24 official capacity as Director of the Arizona )
Health Care Cost Containment System, )
25 )
)
26
Defendants. )
27 )
)
28 )
1 Plaintiffs, by their undersigned attorneys, bring this civil action for declaratory and
2 injunctive relief, and allege as follows:
3 INTRODUCTION
4 1. This is a civil rights class action brought by the Named Plaintiffs, children in
5 Arizona state foster care custody, on behalf of themselves, a general class of children who
6 are or will be placed in such custody following reports that they have suffered child abuse
7 or neglect, and certain subclasses of these children.
8 2. Plaintiffs are among the State’s most vulnerable citizens. Through no fault of
9 their own, they find themselves in the legal custody of the State after having already
10 suffered the trauma of being abused or neglected by their own families. Plaintiffs seek
11 declaratory and injunctive relief to end certain child welfare policies and practices
12 described herein exposing them to yet further physical and emotional harm and
13 unreasonable risk of harm while in the State’s care.
14 3. On May 29, 2014, legislation was enacted giving responsibility for the state’s
15 child welfare operations to the state Department of Child Safety (“DCS”) and removing
16 such responsibility from the state Department of Economic Security (“DES”). As of May
17 29, 2014, DCS, which was established as an independent agency, is legally responsible for
18 managing the state’s child welfare system.
19 4. Plaintiffs name Gregory McKay, the Director of DCS, as a defendant. Defendant
20 McKay, who is sued solely in his official capacity, directly and indirectly controls and is
21 responsible for the policies and practices of DCS, including those set forth herein.
22 5. Plaintiffs also name Cara M. Christ, M.D., the Director of the state Department
23 of Health Services (“DHS”), as a defendant. DHS is responsible for providing mental and
24 behavioral health services to children in Arizona state foster care custody. Defendant
25 Christ, who is sued solely in her official capacity, directly and indirectly controls and is
26 responsible for the policies and practices of DHS, including those set forth herein.
27 6. Plaintiffs also name Thomas J. Betlach, the Director of the Arizona Health Care
28 Cost Containment System (“AHCCCS”), as a defendant. AHCCCS is responsible for
2
1 administering and supervising the Medicaid program in Arizona. Defendant Betlach, who
2 is sued solely in his official capacity, directly and indirectly controls and is responsible for
3 the state’s compliance with Medicaid’s statutory and regulatory requirements.
4 7. Over the past several years, while foster care rates across the nation have been on
5 the decline, Arizona has experienced a dramatic increase in the number of children in state
6 foster care. From 2003 to 2012, the number of children in the State’s foster care custody
7 nearly doubled. More recently, Arizona’s foster care population grew from 10,207 as of
8 March 31, 2010 to 15,037 as of September 2013, a 47.3% increase. The number of
9 children in out-of-home care grew by another 10% from February 2013 to February 2014.
10 As of September 30, 2014, there are 16,990 children in state foster care custody who have
11 been placed in out-of-home care.
12 8. This huge growth in the state’s foster care population has been fueled by
13 extensive state budget cuts to important support services that had previously helped keep
14 families together. In particular, state funding for DES’s contracts with community-based
15 providers who offered in-home services to children, aimed at making removal of children
16 into foster care unnecessary, was cut in half in recent years, from $43 million in fiscal year
17 2008 to under $22 million in fiscal year 2012.
18 9. These cuts followed the state’s termination of its Family Builders program in
19 2004, which had provided family-centered assessments, case management, and services for
20 families with children deemed to be at low or only potential risk of being abused or
21 neglected.
22 10. According to the Arizona Chapter of the American Academy of Pediatrics
23 “[c]uts to DES family support services including child care assistance, housing assistance,
24 substance-abuse treatment and job training for families has resulted in a 40% increase in
25 the number of children who needed to be placed in foster care since 2009 and these
26 children are staying in foster care longer because their parents are not provided with the
27 services they need.”
28
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1 11. As former Governor Brewer publicly acknowledged in 2014, the Arizona “child
2 welfare system is broken, impeded by years of structural and operational failures.”
3 Defendants DCS and DHS (collectively the “Defendants”) are legally responsible for
4 overseeing this “broken” system.
5 12. Defendants are well aware that the following structural and operational failures
6 continue to plague the state’s child welfare system:
7  A severe shortage in and inaccessibility of physical, mental and
behavioral health services available to children in state care. As a result,
8 far too many children in state foster care custody do not receive the health
care services they desperately need and all children in state care are subject
9 to an unreasonable risk that they will suffer physical and emotional harm and
deterioration while in the state’s care.
10
 A widespread failure to conduct timely investigations of reports that
11 children have been maltreated while in state foster care custody. As a
result of the state’s deficient investigation practices, children in state foster
12 care custody are placed at an undue risk of suffering physical and emotional
13 harm while in state care.
 A severe and sustained shortage of family foster homes. As a result of
14 this shortage, children in state foster care are emotionally harmed and
subjected to an unreasonable risk of harm by being placed far from their
15 families and communities, separated from their siblings, and forced to
16 experience disruptive school changes.
 A widespread failure to engage in basic child welfare practices aimed at
17 maintaining family relationships, such as placing siblings together,
18 placing children with their biological parents on a trial reunification
basis, coordinating visits between children in state foster care and their
19 biological families, and having caseworkers make regular visits with the
children’s biological parents to monitor progress toward family
20 reunification. These failures subject children in state foster care to an
unreasonable risk of suffering emotional harm while in state care. Moreover,
21 as a result of these deficiencies, children are subjected to unreasonable
delays in being reunified with their families, causing them to suffer further
22 emotional harm.
23 13. The state child welfare agency and DHS have failed to remedy these ongoing
24 failures.
25 14. Moreover, Arizona officials have long been aware of these deficiencies and
26 harms. As far back as 2003, the Maricopa County Attorney’s Office released a report on
27 the state’s child welfare system, In Harm’s Way, detailing the system’s deficiencies.
28 Among its findings, the report identified a shortage of foster homes and stated that “[p]art
4
1 of the reason many feel that children stay in a ‘risky’ situation is the inability to place them
2 elsewhere.” The report concluded that the state’s child welfare system was “overloaded
3 without the proper resources to ensure the safety of all children.”
4 15. That same year, then Governor Janet Napolitano acknowledged that “[t]he
5 system for protecting Arizona’s children from abuse and neglect, which has been falling
6 apart for years due to poor design and chronic under-funding, is in critical need of repair.”
7 Governor Napolitano convened an “Advisory Commission on CPS Reform” that issued an
8 Action Plan for Reform of Arizona’s Child Protection System in September 2003 (the
9 “Action Plan”). The Action Plan noted several systemic deficiencies in the state’s child
10 welfare system, including a shortage of foster homes and limited access to services for
11 foster children.
12 16. In the years since In Harm’s Way and the Action Plan were released, the child
13 welfare system has continued to suffer from a vast shortage of foster homes and inadequate
14 access to child services, despite the known harm that these structural impairments have
15 caused children in state foster care to suffer.
16 17. As a result of the state’s failure to remedy these problems, plaintiffs have been,
17 and continue to be, exposed to harm and an unreasonable risk of harm, in violation of their
18 federal constitutional and statutory rights.
19 JURISDICTION AND VENUE
20 18. This action is brought pursuant to 42 U.S.C. § 1983 to redress violations of the
21 United States Constitution and the provisions of the federal Medicaid Act, including
22 42 U.S.C. §§ 1396a(a)(10)(A)(i)(I), 1396a(a)(43)(C), 1396d(a)(4)(B) and 1396d(r), that
23 require states to provide early and periodic screening, diagnostic and treatment (“EPSDT”)
24 services. This Court has jurisdiction pursuant to 28 U.S.C. §§ 1331 and 1343(a)(3), and
25 authority to grant declaratory relief under 28 U.S.C. §§ 2201 and 2202.
26 19. Venue is proper here pursuant to 28 U.S.C. § 1391(b) because the claims arise
27 in this district.
28
5
1 PARTIES
2 A. The Named Plaintiffs
3 B.K.
4 20. As of February 3, 2015, B.K. is a ten-year-old girl in state foster care with a
5 permanency goal of permanent foster care, meaning that DCS has concluded that she has
6 little, if any, chance of leaving foster care over the next eight years. She has spent more
7 than half of her life in state foster care. During her time in state foster care, B.K. has been
8 deprived of needed physical and mental health care, separated from her siblings, deprived
9 of contact with her mother and siblings, and placed in institutional settings on two different
10 occasions. As a result of these experiences, B.K. has been subjected to emotional harm
11 and/or an ongoing unreasonable risk of harm.
12 21. B.K. first entered voluntary state custody in 2005 when she was five months
13 old. At that time, B.K.’s mother had a substance abuse problem and could not care for her.
14 B.K. remained in the legal custody of the state child welfare agency until September 2006
15 when she was returned to her mother.
16 22. In 2008, then three-year-old B.K. and her three siblings were removed from
17 their mother’s home. Upon assuming their care, the state child welfare agency
18 immediately separated the four siblings, placing B.K. and her brother in a licensed foster
19 home, and their two sisters in a second foster home. In late 2009, the state child welfare
20 agency returned B.K. and her siblings to their mother’s care.
21 23. In 2012, B.K. and her three siblings were again removed from their mother’s
22 home and placed in state foster care custody. Upon coming into state care for the third
23 time, B.K. was diagnosed with Posttraumatic Stress Disorder (“PTSD”), a mood disorder,
24 psychosis and anxiety. An investigation showed that B.K. had been physically abused by
25 her mother, and had bumps and bruises on her head and behind her ears.
26 24. Despite her fragile emotional state, the state child welfare agency separated
27 B.K. from all of her siblings, placing her in a group home on “emergency shelter” status.
28
6
1 Though such placements are supposed to be short-term, B.K. remained at the group home
2 for more than two years.
3 25. While at the group home, the state child welfare agency failed to ensure that
4 B.K. obtained the glasses she needed to see properly. The state child welfare agency also
5 failed to discover that B.K. was walking with a limp, and failed to make sure that she
6 received the orthopedic shoes she needed. Despite months of complaints from B.K. about
7 a toothache, the state child welfare agency failed to make sure she saw a dentist while she
8 was living at the group home.
9 26. From the time B.K. was placed at the group home in 2012 until early 2014, the
10 state child welfare agency and DHS also failed to ensure that B.K. received consistent
11 counseling and needed mental health services. During this time, B.K. was saying that she
12 was hearing voices that were telling her to hurt other people or that someone would die.
13 One time she was so scared by the voices that she called the police. The state child
14 welfare agency knew that the group home was failing to arrange for B.K.’s transportation
15 to appointments with health care providers, but failed to see to it that B.K. received
16 undisrupted services. The group home also enrolled B.K. in a specialized school where
17 she was the only girl.
18 27. In May 2014, the state child welfare agency finally placed B.K. in a foster home
19 after she had spent 25 months in the group home. The state child welfare agency placed
20 her with a man and his great-nephew who went to the same specialized school as B.K.
21 The man told the state child welfare agency that he was concerned about B.K.’s mental
22 health and asked the state to make sure she received an updated psychological evaluation.
23 The last complete evaluation had been conducted five years earlier when B.K. was four.
24 The updated assessment was never performed. After only eight weeks, B.K. was moved to
25 a second foster home with neighbors of the man and his great-nephew. After two weeks at
26 this second home, the foster parents packed up B.K.’s things and dropped her off at a DCS
27 office.
28
7
1 28. In August 2014, DCS moved B.K. to a shelter. The move to shelter care caused
2 B.K. to have to change schools, resulting in educational and social disruption. Moreover,
3 the counselor who had been treating B.K. at the group home refused to drive to see B.K. at
4 the shelter because of the distance involved, and DCS again failed to ensure that B.K.
5 received transportation to her counseling sessions.
6 29. During August 2014, B.K.’s behavioral health coordinator concluded that B.K.
7 should be placed in a “Home Care Training to Home Care Client Services” (“HCTC”)
8 therapeutic foster home. No such placement was made and B.K. remained in a shelter
9 until September. While at the shelter, B.K. had no contact with her mother or three older
10 siblings, even though her siblings have been returned to their mother’s care. B.K.’s mental
11 health deteriorated at the shelter and she threatened to hurt herself and others. She was
12 admitted to a psychiatric hospital for a week to be stabilized.
13 30. In late September 2014, DCS moved B.K. from the hospital to a non-therapeutic
14 foster home. This resulted in another change in schools. DCS did not ensure that she had
15 regular contact with her mother or siblings.
16 31. In December 2014, still waiting to be placed in an HCTC home, B.K. had
17 another psychiatric crisis and threatened suicide. The state child welfare agency moved
18 her out of the foster home and DHS admitted her to another psychiatric hospital. She
19 stayed in the hospital for a week and a half.
20 32. In late December, months after her providers agreed she needed a therapeutic
21 foster home, B.K. was finally discharged from the hospital to an HCTC placement. This
22 resulted in yet another change in schools.
23 C.P.
24 33. As of February 3, 2015, C.P. is a seven-year-old boy who has been in state
25 foster care custody since June 2013, with a permanency goal of adoption. During his time
26 in state foster care, he has attended at least eight different schools and has had to live in at
27 least 11 different placements, including two stays in shelters and a placement in a foster
28 home where he was physically abused. While in state foster care, he has been separated
8
1 from his siblings, deprived of visits with them, and has been deprived of access to both the
2 mental health services and placements he desperately needs. As a result of these
3 experiences, C.P. has been subjected to physical and emotional harm and/or an ongoing
4 unreasonable risk of harm.
5 34. C.P. and his two sisters were taken into state foster care custody after being
6 exposed to neglect and domestic violence. They were initially placed in an unlicensed
7 foster home for four days before being moved to their grandmother’s home. During the
8 two-month period that C.P. was with his grandmother, she repeatedly asked the state child
9 welfare agency for help with C.P.’s mental health needs, but C.P. did not receive any
10 mental health care services. Ultimately, his grandmother asked the state child welfare
11 agency to remove C.P. and his siblings from her home.
12 35. The state child welfare agency then separated C.P. and his older sister from their
13 younger sister. C.P. and his older sister were placed in a Spanish-speaking foster home,
14 even though the children do not speak Spanish. The home was almost an hour away from
15 C.P.’s grandmother and the foster home where C.P.’s younger sister was placed. Within
16 ten days of arriving at the Spanish-speaking foster home, C.P. and his older sister were
17 separated and placed in two different foster homes.
18 36. In early September 2013, the state child welfare agency moved C.P. to yet
19 another foster home. After months in foster care, C.P. was belatedly assigned a therapist.
20 Even then, however, C.P.’s foster mother refused to take C.P. to his appointments and the
21 state child welfare agency and DHS failed to arrange for other transportation. As a result,
22 C.P. did not have a single therapy session during the four months he lived at the foster
23 home.
24 37. The foster mother was also reported to the state Child Abuse Hotline, to C.P.’s
25 DES case manager and to the state licensing office, after she placed C.P. in the front seat
26 of her car without a car seat or booster seat. DCS did not conduct an investigation of these
27 reports. Moreover, the case manager acknowledged that she had made an earlier report to
28
9
1 the Child Abuse Hotline herself when it was discovered that the foster mothe r had left C.P.
2 unsupervised with another foster child. DCS did not investigate that report either.
3 38. In January 2014, C.P. began visiting at another home where his older sister was
4 living. When his foster mother failed to pick him up from a visit, the state child welfare
5 agency simply told the family whom C.P. was visiting to keep him. C.P. subsequently
6 disclosed that his former foster mother had hit him with a spoon. Though the state child
7 welfare agency investigated the reported abuse, DCS never entered any investigation
8 findings into the agency’s Children’s Information Library and Data Source (“CHILDS”)
9 system, nor did the state child welfare agency close the investigation.
10 39. C.P. started living at the new foster home with his older sister in January 2014.
11 Shortly thereafter, he became suicidal. Though he had a crisis stabilization team in place,
12 it failed to promptly respond to this crisis, and the foster mother called the police who took
13 C.P. to the hospital. C.P. did not see his older sister again for nearly a year.
14 40. C.P. was admitted to a psychiatric hospital for a week. He was diagnosed with
15 PTSD and his doctors indicated that he needed immediate intensive trauma therapy and
16 specialized therapy at a therapeutic HCTC home. C.P.’s stabilization team agreed that
17 C.P. needed to be placed in a foster home equipped to respond to his needs. Nevertheless,
18 when C.P. left the hospital, the state child welfare agency took him directly to a shelter.
19 He spent ten days in that shelter before being moved to a second shelter, a move that also
20 resulted in C.P. having to change schools.
21 41. In February 2014, three weeks after arriving at the second shelter, C.P. became
22 suicidal again, telling staff about his plan to get a knife and hurt himself. He was
23 hospitalized for a second time and prescribed psychotropic medication. He remained in
24 the hospital for two weeks before being discharged in March 2014. Again, the doctors at
25 the psychiatric hospital recommended that C.P. be released to a therapeutic HCTC home.
26 42. Instead, the state child welfare agency placed C.P. in a non-therapeutic foster
27 home. C.P. had to switch schools again and was inappropriately placed in first grade
28 instead of kindergarten, where he should have been enrolled based on his age and school
10
1 experience. He stayed in first grade for a month before anyone realized he was in the
2 wrong grade.
3 43. In April 2014, the state child welfare agency finally placed C.P. in an HCTC
4 home. Unfortunately, he was required to switch schools again as a result of this latest
5 placement.
6 44. In December 2014, both of C.P.’s two sisters were adopted. During the year
7 before they were adopted, C.P. had only one sibling visit with one of his sisters, even
8 though his mental health assessments indicate that his sisters are the only people with
9 whom he has meaningful attachments. Moreover, as of February 3, 2015, not only has he
10 had no contact with either of them since they were adopted, but he has not received the
11 intensive trauma therapy that was recommended for him in January 2014, and because his
12 HCTC placement is temporary, his providers have decided that he should not receive
13 intensive trauma therapy until he is in a more stable home.
14 B.T.
15 45. As of February 3, 2015, B.T. is a fourteen-year-old boy diagnosed with PTSD
16 who has a permanency goal of adoption. During his many years in state foster care
17 custody, he has been shuffled through numerous institutional settings despite his young
18 age, separated from his siblings, denied sibling visitation, deprived of much needed mental
19 health care, and has had to endure repeated educational disruptions. As a result of these
20 experiences, B.T. has been subjected to emotional harm and/or an ongoing unreasonable
21 risk of harm.
22 46. In January 2005, B.T. was taken into foster care for the first time, along with his
23 two older brothers. B.T. and one of his older brothers were placed together in a group
24 home, and the other brother was separated and placed in a different group home.
25 47. A month after being taken into state foster care, B.T. had a psychological
26 evaluation, which indicated that he needed therapeutic treatment. He had to wait six
27 months before his first therapy session.
28
11
1 48. In June 2005, B.T. was removed from the group home and separated from the
2 brother with whom he was placed there. He was moved to a kinship foster home with a
3 paternal aunt. By December 2005, B.T. had spent six months in his new home without any
4 visits with his older brothers. He did not see his brothers again until January 2006.
5 49. In August 2006, B.T.’s aunt told the state child welfare agency that B.T. was not
6 receiving the counseling that he needed. She requested that B.T. have an updated
7 psychological evaluation, but no such evaluation was conducted. During this same time
8 period, the state child welfare agency was again failing to provide B.T. with regular visits
9 with one of his brothers.
10 50. In September 2006, B.T.’s aunt told the state child welfare agency that she
11 could no longer care for B.T. since the state was not providing him with the mental health
12 services he needed. Rather than DHS providing those services, the state child welfare
13 agency moved B.T. to an emergency receiving foster home.
14 51. In October 2006, B.T. threatened to kill himself and the foster family with
15 whom he was temporarily placed. Despite his mounting mental health issues, B.T. still
16 was not receiving regular therapy. The state child welfare agency responded to this latest
17 crisis by removing B.T. from the home. B.T., then six years old, was again placed in a
18 group home.
19 52. Shortly thereafter, the state child welfare agency received reports that B.T. was
20 struggling emotionally in the group home. Again, an updated psychological evaluation for
21 B.T. was requested, but the evaluation was not scheduled until December 2006. The state
22 child welfare agency and DHS also failed during this time to ensure that B.T. received
23 needed counseling.
24 53. B.T.’s evaluation indicated that he needed individual therapy every other week.
25 He was also prescribed psychotropic medication. A psycho-educational evaluation was
26 recommended, but never conducted.
27
28
12
1 54. In January 2008, B.T. was placed in a pre-adoptive home with one of his
2 brothers. A month later, the family told the state child welfare agency that B.T. needed
3 more intensive counseling and a different counselor who could better meet B.T.’s needs.
4 55. In August 2008, both B.T. and his brother were adopted. In March 2011,
5 however, they were both taken back into state foster care. Shortly after this occurred, B.T.
6 reported that his adoptive father had been beating him with a belt.
7 56. The state child welfare agency immediately separated B.T. from his brother,
8 placing the two boys in different non-therapeutic group homes. The group home where
9 B.T. was placed told the state child welfare agency that B.T. desperately needed
10 counseling. Despite this, B.T. did not receive any counseling while at the group home.
11 57. A month after being brought back into state foster care, B.T. was hospitalized in
12 an acute care mental health facility for two weeks. After leaving the hospital, the state
13 child welfare agency returned B.T. to the group home.
14 58. Once back at the group home in May 2011, B.T.’s mental health worsened.
15 DHS approved B.T. for a therapeutic HCTC placement, but did not have one available for
16 him.
17 59. Stuck in the group home, B.T. responded by trying to run away. B.T. spent the
18 night at a juvenile detention center. In that one night, his group home filled his open bed
19 with another child. As a consequence, the state child welfare agency moved B.T. to a new
20 group home hours away from his prior placement.
21 60. In July 2011, B.T. was moved to an HCTC home, but he was still not receiving
22 trauma therapy and no psycho-sexual evaluation had been completed, despite one having
23 been recommended months earlier. It was not until October 2011 that a psycho -sexual
24 evaluation was conducted.
25 61. During April 2012, the state child welfare agency and DHS began looking for
26 another HCTC placement to better meet B.T.’s needs. Unable to find one, the state child
27 welfare agency instead moved him to a non-therapeutic group home/shelter in August
28 2012. By October 2012, B.T. reported “I feel like I get tossed around like a bag of chips.”
13
1 He threatened to kill himself three times while in this non-therapeutic congregate care
2 placement.
3 62. In November 2012, the shelter told the state child welfare agency that B.T.
4 needed a higher level of care. The next month he was moved again, this time to a
5 therapeutic group home. While placed there, B.T. continued to express suicidal thoughts.
6 63. In January 2013, B.T. was returned to the same non-therapeutic group
7 home/shelter that had told the state just two months earlier that B.T. needed a higher level
8 of care. B.T. remained at that shelter for a few more weeks before the state child welfare
9 agency moved him again to a therapeutic group home two hours from his home
10 community. In May 2013, the brother with whom B.T. was adopted in 2008 was placed in
11 a pre-adoptive placement with a family that ultimately adopted him. B.T. felt defeated and
12 said he thought he would never get out of the group home. The following month, B.T.
13 grabbed the steering wheel of a van driven by group home staff, saying, “I want us all to
14 die.” That same day, the state’s therapeutic team coordinating B.T.’s behavioral health
15 services reported that “with a few exceptions, B.T. is doing well over the last 2 weeks.”
16 64. Following the apparent suicide attempt, B.T.’s treating psychiatrist
17 recommended that B.T. be placed in a residential treatment facility. An application was
18 made the following month. While that request was pending, the state child welfare agency
19 moved B.T. to another therapeutic group home far from his home county. In September
20 2013, the state child welfare agency moved B.T. to yet another therapeutic group home.
21 65. In March 2014, the state child welfare agency moved B.T. to a non-therapeutic
22 family foster home, but this placement disrupted after DHS failed to provide B.T. with any
23 therapy to support his transition to a family home. In July 2014, B.T. was moved to
24 another non-therapeutic foster home. By September, B.T. had only had a single therapy
25 session.
26 66. In October, DCS moved B.T. to a shelter where he stayed for more than a
27 month. B.T. did not receive any therapy sessions in the placement. In early November,
28 his Child and Family Team (“CFT”) recommended and the state child welfare agency and
14
1 DHS approved B.T. for a therapeutic HCTC placement. No such placement was made.
2 Instead, DCS placed B.T. in another therapeutic group home.
3 67. Almost every time the state child welfare agency has moved B.T. over the last
4 three and a half years, he had to go to a new school.
5 68. In December 2014, B.T. threatened to commit suicide while living in the
6 therapeutic group home. In January 2015, B.T. was placed in juvenile detention in
7 Maricopa County following an incident in a prior group home.
8 69. Now 14 years old, B.T. has spent half his life in Arizona foster care custody and
9 does not expect to find a permanent family.
10 A.T.
11 70. As of February 3, 2015, A.T. is a ten-year-old boy in state foster care living in a
12 non-therapeutic group home, with a permanency goal of adoption. He was taken into state
13 foster care custody most recently in September 2011 with his nine-year-old brother.
14 During his time in state foster care, A.T. has been placed in institutional care; deprived of
15 necessary physical, dental and mental health care services; separated from his brother and
16 deprived of sibling visitation; and, has been subject to missed visits by his state child
17 welfare caseworker. As a result of these experiences, A.T. has been subjected to emotional
18 harm and/or an ongoing unreasonable risk of harm.
19 71. A.T. and his younger brother were taken into state foster care custody after their
20 father committed suicide in mid-2011. This was their second time in state foster care.
21 They had also been in state foster care custody prior to 2007. Their mother’s parental
22 rights were terminated in January 2007.
23 72. Following their father’s suicide, the state child welfare agency placed A.T. and
24 his brother in an unlicensed kinship home with an uncle, his wife and their young son. In
25 November 2011, A.T.’s brother was removed from the home and placed in a therapeutic
26 group home. A.T. remained with his uncle’s family.
27 73. During the period from November 2012 to March 2013, the state child welfare
28 agency failed to arrange for sibling visits between A.T. and his brother, and A.T.’s state
15
1 caseworker failed to make monthly visits, as required under state policy. In February
2 2013, the state child welfare agency was ordered to ensure that the boys had visitation with
3 each other twice weekly. The state child welfare agency was also ordered to transfer
4 A.T.’s case to the adoption unit to begin the process of finding a permanent family. As
5 alleged below, the state child welfare agency failed to comply with that order.
6 74. As of March 2013, A.T. had not had a routine physical or seen a dentist in a
7 year.
8 75. At a status hearing in April 2013, the juvenile court made a finding of “no
9 reasonable efforts” against the state child welfare agency for its failure to arrange for
10 sibling visitation, to help A.T. progress with his schooling, and to transfer A.T.’s case to
11 the adoption unit. Despite this ruling, and despite the fact that A.T. had been free for
12 adoption since he re-entered care in 2011, the state child welfare agency still failed to
13 transfer A.T.’s case to the adoption unit 13 months later, in May 2014.
14 76. In November 2013, a mental health evaluation was scheduled for A.T. and his
15 brother. The appointment could not proceed because the state child welfare agency and
16 DHS failed to arrange transportation for the boys. As a result, the evaluation had to be re-
17 scheduled for the following month.
18 77. The evaluation was not completed until February 2014. The evaluator
19 concluded that more information was needed with regard to A.T.’s response to his father’s
20 suicide before any therapeutic services could be recommended. Nonetheless, the state
21 child welfare agency and DHS failed to request any further assessments.
22 78. In February 2014, A.T. also reported that his aunt and uncle left him for two to
23 three hours at a time to care for his five-year-old cousin while they delivered newspapers
24 in the early mornings. Around the same time, A.T.’s uncle posted a video on YouTube of
25 himself tasering a 15-year-old child living in the house while another child is heard crying
26 in the background. A.T.’s aunt and uncle were also using corporal punishment to
27 discipline A.T. While these facts were known to the state child welfare agency, it never
28 investigated them.
16
1 79. That same month, A.T.’s uncle and aunt announced that they were leaving the
2 state and would not be taking A.T. with them. A.T. was thereupon removed from the
3 uncle’s home and placed in the same foster/adoptive home as his brother, but no services
4 were put in place for the first three weeks to help A.T. with the transition. Shortly after
5 being placed in the foster/adoptive home, A.T. started saying he wanted to die.
6 80. The state child welfare agency subsequently moved A.T. to an emergency
7 respite foster home. His brother’s foster family told the state child welfare agency it was
8 willing to have A.T. return to live with them, but not until A.T. received the behavioral
9 health services he needed. Nevertheless, in April 2014, the state child welfare agency
10 moved A.T. to a non-therapeutic group home out of his home county and 1½ hours away
11 from his brother. The state child welfare agency did not arrange visits between the two
12 boys.
13 81. In May 2014, the juvenile court directed the state child welfare agency to
14 immediately place A.T. back in his home county. As A.T. was receiving no therapy or
15 counseling at the time, the court also ordered the state child welfare agency to obtain
16 therapy for A.T. immediately, beginning no later than the end of the month. However, in
17 July 2014, DCS and DHS again failed to coordinate A.T.’s transportation and A.T. was
18 unable to go to his scheduled psychological evaluation.
19 82. Despite the May 2014 court order, A.T. remained in a non-therapeutic group
20 home two hours away from his home community for five months. During that time he had
21 to travel nearly two hours each way to obtain needed mental health services. DCS moved
22 A.T. to a non-therapeutic group home in his home county in September 2014.
23 The C-B Siblings
24 83. The C-B siblings include two brothers, A.C-B and M.C-B, and two sisters, J.C-
25 B and D.C-B, all of whom were taken into state foster care custody in January 2014. As of
26 February 3, 2015, A.C-B is six years old, M.C-B is eight years old, J.C-B is three years old
27 and D.C-B is seven years old. Also as of that date, their permanency goal is reunification.
28 During their time in state foster care, they have been unnecessarily separated, deprived of
17
1 needed mental health care and parental visitation, and the sisters were placed in an
2 inappropriate institutional setting. As a result of these experiences, they have been
3 subjected to emotional harm and/or an ongoing unreasonable risk of harm.
4 84. Because of the traumatizing circumstances that led to their being taken into
5 foster care, the siblings’ lawyer requested at the first juvenile court hearing of the case in
6 January 2014 that DHS immediately provide the children with trauma therapy. As alleged
7 further below, the state child welfare agency and DHS delayed those services for nine
8 months.
9 85. The state child welfare agency initially placed the four siblings with a relative
10 2½ hours away from the home from which they were removed. Because of this distant
11 placement, their urgent response assessments, required for every child taken into foster
12 care, were delayed, and the children never received any behavioral health services while in
13 this placement.
14 86. In March 2014, the state child welfare agency removed the children from the
15 relative and placed them in separate locations. The state child welfare agency placed
16 eight-year-old M.C-B and five-year-old A.C-B in a licensed family foster home. Six-year-
17 old D.C-B and two-year-old J.C-B were placed in a non-therapeutic group home. None of
18 the siblings received behavioral health services while in these placements.
19 87. That same month, M.C-B and A.C-B’s foster parents requested that M.C-B
20 receive a psychological evaluation. The evaluation was not conducted for eight months.
21 88. In April 2014, the state child welfare agency moved all four of the C-B siblings
22 to their father’s home. The children’s state child welfare case manager never visited them
23 in the home. The state child welfare agency and DHS also failed to ensure that any of the
24 children received behavioral health services or counseling, even though D.C-B and A.C-B
25 were exhibiting sexualized behaviors indicative of possible sexual abuse. Only two weeks
26 after being placed there, the children’s father requested that the state child welfare agency
27 remove them.
28
18
1 89. In May 2014, the state child welfare agency again split up the siblings, this time
2 into three different foster homes. M.C-B and A.C-B were placed in the same foster home
3 where they had previously been placed. The state child welfare agency placed each of the
4 girls, D.C-B and J.C-B, in separate foster homes.
5 90. From the time they were taken into custody to May 2014, none of the siblings
6 had any visits with their biological mother.
7 91. Following a juvenile court hearing in early June 2014, DCS agreed to ensure
8 that all four children receive therapy – not just an intake or enrollment – with a trauma
9 therapist by June 20. DCS also agreed to pay for the services if DHS would not pay. In
10 addition, the court directed DCS to provide the children with relational therapy with both
11 parents. DCS further agreed to work with the children’s father to help meet his
12 transportation needs in order to facilitate visitation with the children, including providing
13 him with a gas card. DCS failed to provide any of these services or supports.
14 92. Consequently, on July 2, 2014, the juvenile court made a “no reasonable
15 efforts” finding with regard to DCS’s failure to provide services for the siblings. The court
16 called the agency’s conduct “appalling.”
17 93. In late July 2014, D.C-B was placed in the same foster home as M.C-B and
18 A.C-B. As of February 3, 2015, J.C-B remains in a separate foster home.
19 94. In August 2014, eight months after being brought into foster care, the three
20 eldest siblings finally had their behavioral health evaluations completed.
21 95. In mid-September 2014, nine months after being taken into foster care, M.C-B
22 and A.C-B had received only one therapy session. Though their CFT recommended that
23 they receive weekly therapy sessions, the facility where the therapist is located can only
24 accommodate therapy sessions every other week.
25 96. By September 2014, D.C-B had received only two sessions with a therapist.
26 J.C-B had an intake meeting with her therapist, but her therapy sessions had not yet started.
27
28
19
1 97. In December 2014, DHS had only just begun the psychological evaluation that
2 M.C-B’s foster parents first requested in March 2014. In addition, M.C-B and A.C-B are
3 both struggling in school with attention problems.
4 J.M.
5 98. As of February 3, 2015, J.M. is a nine-year-old boy with a permanency goal of
6 adoption. He was taken into state foster care when he was six years old. During his time
7 in state foster care custody, J.M. has been deprived of needed mental health care, placed in
8 institutions on numerous occasions, and has had his education repeatedly disrupted. As a
9 result of these experiences, J.M. has been subjected to emotional harm and/or an ongoing
10 unreasonable risk of harm.
11 99. J.M. was brought into state foster care in May 2012. The state child welfare
12 agency initially placed him in a shelter for five days, then moved him to live with his
13 grandmother. When she could not care for him, the state child welfare agency moved J.M.
14 to a group home in a different county. J.M. remained there for two months.
15 100. In July 2012, the state child welfare agency moved J.M. to an unlicensed
16 kinship home back in his home community. J.M. entered first grade that summer. The
17 state child welfare agency failed to ensure that J.M. had transportation to and from school.
18 As a consequence, J.M. missed sixty days of schooling.
19 101. In September 2013, J.M. was moved to another kinship placement two hours
20 from his home county. As a result of this placement change, J.M. had to start second grade
21 at a new school. The move also resulted in a change in J.M.’s mental health providers,
22 disrupting his mental health care.
23 102. In October 2013, the state child welfare agency moved J.M. to a licensed
24 family foster home back in his home county, resulting in yet another school change for
25 J.M.
26 103. In February 2014, the state child welfare agency moved J.M. to a non-
27 therapeutic group home in another county two hours away. As a result, he had to enroll at
28 his fourth school in less than two years since being brought into state foster care. His
20
1 teachers began developing an Individualized Education Program (“IEP”) for him, but it
2 was not finalized or implemented. He was also diagnosed with ADHD.
3 104. Between February and June 2014, J.M. had to move among four different
4 group homes, all two hours from his home community. During this period, DHS took the
5 position that J.M. could not be placed in an HCTC therapeutic foster home until he had
6 first received, and exhausted, out-patient counseling. But each time J.M. was forced to
7 move to a different group home, he had to start his therapy over again with a new therapist.
8 105. J.M.’s visitation with his mother was also disrupted when he was moved
9 among these various group homes. J.M. has no siblings and his mother is his only intimate
10 family relationship. She had trouble traveling the two hours by bus to see J.M. at his group
11 homes and the state child welfare agency refused to coordinate alternative transportation
12 for her. Instead, the state child welfare agency required eight-year-old J.M. to travel three
13 hours each way in a transport van for a two-hour visit with his mother.
14 106. In June 2014, DCS removed J.M. from his most recent group home and
15 returned him to a shelter. This placement resulted in another disruption in his education
16 and mental health treatment. With each educational disruption, J.M.’s new school has had
17 to re-start the IEP process of assessment and planning. DCS has failed to ensure that his
18 IEP was completed or provided to his new school, which had to be ordered by the juvenile
19 court.
20 107. Later in June 2014, the state child welfare agency and DHS finally approved
21 J.M. for an HCTC placement after counseling proved inadequate. However, at that time,
22 there were no HCTC placements available and J.M. continued to live at the shelter for four
23 months. In late October, DCS moved him to a licensed non-therapeutic foster home. It
24 was not until November 2014 that his current school concluded the necessary evaluations
25 and finalized his IEP.
26 J.C.
27 108. As of February 3, 2015, J.C. is a ten-year-old boy with a permanency goal of
28 adoption. He was taken into state foster care when he was eight. During the 2½ years he
21
1 has been in Arizona foster care, J.C. has suffered delays in needed health care treatment
2 after being diagnosed with PTSD; he has been placed in inappropriate institutional
3 settings; and he has been shuffled through numerous schools. He was also physically
4 abused while in state foster care custody. As a result of these experiences, J.C. has been
5 subjected to emotional and physical harm and/or an ongoing unreasonable risk of harm.
6 109. J.C. was brought into state foster care custody in March 2012. He displayed
7 behaviors that suggested he had been sexually abused, and was placed in an HCTC home.
8 However, in September 2012, he was moved from that home and placed in a non-
9 therapeutic group home. Not surprisingly, his mental health immediately deteriorated.
10 Among other things, he soiled his pants and banged his head against the wall. Despite this,
11 the state child welfare agency kept J.C. in the group home for seven months.
12 110. The state child welfare agency moved J.C. back with his father in March 2013,
13 while retaining legal custody over J.C. J.C.’s father did not take J.C. to his therapy
14 sessions. Nonetheless, the state child welfare agency left J.C. with his father and failed to
15 ensure that J.C. received the care he needed.
16 111. Two months later, nine-year-old J.C. attempted suicide by taking an overdose
17 of his psychotropic medication. He was transported to the emergency room and admitted
18 to a psychiatric hospital for ten days. The state child welfare agency then returned him to
19 his father’s home, still retaining legal custody over J.C.
20 112. In March 2014, J.C. disclosed that his father had been physically abusing him
21 by hitting him with a belt. The state child welfare agency then removed J.C. from his
22 father’s home. The abuse was so severe that the police criminally investigated J.C.’s
23 beating.
24 113. After removing him from his father, the state child welfare agency placed J.C.
25 in a non-therapeutic group home. As a result of this placement change, J.C. had to change
26 schools and has had significant problems adjusting. In July, DCS moved J.C. again, this
27 time to a therapeutic group home in another county, resulting in another school disruption.
28
22
1 In August 2014, DCS moved J.C. to an HCTC foster home. As of February 3, 2015, he is
2 still living there.
3 B. The Next Friends
4 114. Pursuant to Fed. R. Civ. P. 17(c)(2), Named Plaintiffs A.T., A.C-B, M.C-B,
5 J.C-B, D.C-B, J.M., and J.C. appear through their next friend Susan M. Brandt. Ms. Brandt
6 is Social Work Supervisor at the Office of Children’s Counsel in Tucson, Arizona. She
7 resides in Tucson.
8 115. Pursuant to Fed. R. Civ. P. 17(c)(2), Named Plaintiffs B.T. and C.P. appear
9 through their next friend Jennifer L. Kupiszewski. Ms. Kupiszewski is an attorney in
10 private practice in Scottsdale who has previously represented children and parents in
11 dependency matters. She resides in Scottsdale, Arizona.
12 116. Pursuant to Fed. R. Civ. P. 17(c)(2), Named Plaintiff B.K. appears through her
13 next friend Margaret R. Tinsley, a retired attorney who has previously represented children
14 and parents in dependency matters. Ms. Tinsley resides in Tempe, AZ.
15 C. The Defendants
16 117. Defendant Gregory McKay is the Director of DCS and is being sued in his
17 official capacity. Director McKay maintains his principal office at the Department of
18 Child Safety, 1717 West Jefferson S/C005A, Phoenix, Arizona 85007. Director McKay is
19 mandated under state law to carry out the purposes of DCS, including the formulation of
20 policies, plans and programs to effectuate DCS’s missions and purposes.
21 118. Defendant Cara M. Christ, M.D., is the Director of DHS and is being sued in
22 her official capacity. Director Christ maintains her principal office at the Department of
23 Health Services, 150 North 18 th Avenue, Phoenix, Arizona 85007. Director Christ is
24 mandated under state law to administer DHS, including the formulation of policies, plans
25 and programs to provide mental and behavioral health services to children in DCS foster
26 care custody.
27 119. Defendant Thomas J. Betlach is the Director of AHCCCS and is being sued in
28 his official capacity. Director Betlach maintains his principal office at the Arizona Health
23
1 Care Cost Containment System, 801 E. Jefferson Street, MD 4100, Phoenix, Arizona
2 85034. AHCCCS is charged with administering and supervising Arizona’s Medicaid
3 program.
4 FIRST CAUSE OF ACTION – VIOLATION OF PLAINTIFFS’ SUBSTANTIVE
5 DUE PROCESS RIGHTS UNDER THE U.S. CONSTITUTION
6 120. Paragraphs 1-119 above are repeated and re-alleged as if fully set forth herein.
7 121. This claim is asserted against defendants McKay and Christ in their official
8 capacities on behalf of a class of children who are or will be in the legal custody of the
9 Arizona Department of Child Safety due to a report or suspicion of abuse or neglect (the
10 “General Class”).
11 122. DCS provides and is legally obligated to provide members of the General
12 Class with physical and dental health care services through the state Comprehensive
13 Medical and Dental Program (“CMDP”). DCS administers the CMDP.
14 123. DHS provides and is legally obligated to provide members of the General
15 Class with mental and behavioral health services through ADHS Behavioral Health
16 Services (“BHS”). BHS delivers these services through contracts with Regional
17 Behavioral Health Authorities (“RBHAs”) across the state.
18 124. DCS is also responsible for monitoring the physical, behavioral and emotional
19 health status and needs of all members of the General Class and coordinating the physical,
20 behavioral and mental health services provided to those children to ensure that they receive
21 the health care services they need while in state foster care.
22 125. Many children in state foster care need such services to help them cope with
23 the significant trauma to which they were exposed before being removed from their homes.
24 For example, according to the Arizona Office of the Auditor General, “as of September
25 2013, approximately 31 percent of the children in out-of-home care aged 13 or older were
26 clinically diagnosed as emotionally disturbed.”
27 126. DCS and DHS are failing to fulfill their obligations to provide, coordinate and
28 monitor medical, dental, mental and behavioral health services to members of the General
24
1 Class. As a result, members of the General Class are being harmed and subjected to an
2 unreasonable risk of harm and deterioration while in DCS state foster care custody.
3 127. In both its 2011 and 2012 annual reports, Arizona’s state-wide Citizen Review
4 Panel (“CRP”) found that many children in state foster care were not receiving adequate
5 mental and behavioral health assessments and services. The CRP “repeatedly observed
6 untreated mental health problems” among children in state foster care. It also found that a
7 “lack of access to comprehensive and timely mental health assessments and services
8 exacerbated the problems of the children” and resulted in, among other things, “multiple
9 disrupted foster and adoptive placements, delays in children obtaining permanency, and
10 CPS involvement in the next generation of children.”
11 128. Moreover, according to the CRP’s 2012 report, “[w]hen services were
12 provided, they were observed to be brief and limited with cases being closed without
13 observation of sustained behavior changes and few aftercare services in place. When
14 children were removed, delays between the time of referral and assessment were observed
15 to cause even longer delays before intervention was provided.”
16 129. Similarly, in its 2013 Report, the CRP found that “the continuum of services . .
17 . for families is limited.” According to the report, “comprehensive services were lacking
18 and existing services are unable to maintain long term change in these families.”
19 130. The CRP is not alone in noting unacceptable shortages and delays in the
20 provision of needed services. According to a 2012 report issued by DES’s own consultant,
21 “[a]s much as half of the time a child spends in [foster care] is spent waiting on services.”
22 More recently, the Office of the Auditor General’s report on DCS policy and practice
23 recognized the “[i]nadequate access to behavioral health services” for youth in foster care .
24 131. The Arizona Chapter of the Foster Family-Based Treatment Association
25 (“FFTA”) has also noted the severe shortage of mental health services delivered by
26 professional foster homes (also known as “therapeutic foster homes”) to children in state
27 foster care. These services, referred to in Arizona as “Home Care Training to Home Care
28 Client Services” (“HCTC”), are supposed to be available to children in state foster care
25
1 who need therapeutic family-based intervention. These therapeutic foster homes are
2 administered by DHS through RBHAs. DCS pays room and board for children in state
3 foster care placed in HCTC homes.
4 132. There are currently only about 400 HCTC homes for more than 16,500
5 children in state foster care. Moreover, most of these homes are only licensed for 1 or 2
6 placements, severely limiting the number of children for whom these homes are available.
7 The severe shortage of HCTC homes places members of the General Class at an
8 unreasonable risk of deteriorating while in state foster care.
9 133. The shortage of HCTC providers, coupled with the short-term nature of HCTC
10 services (DHS has a practice of requiring such services to be re-authorized every 90 days),
11 also subjects children in state foster care to emotionally harmful placement instability, as
12 children are moved out of HCTC homes far too soon after being placed there. The CRP’s
13 2013 Report specifically found that the HCTC placement structure “causes disruption
14 when a specialized placement is required to meet a child’s needs.” This placement
15 disruption causes children with higher needs to “yo-yo” up and down in terms of their
16 behaviors, thereby driving additional placement moves, which results in even further
17 unnecessary re-traumatization.
18 134. The Arizona Auditor General has also recognized the state child welfare
19 agency’s and DHS’s practice of failing to provide “long-term solutions for children in need
20 of continued support” for their mental health needs. According to the Auditor General’s
21 Report, “[c]hildren whose behavioral health improves in therapeutic foster homes may be
22 moved to less restrictive family settings, but without the same continued support, their
23 behaviors may worsen, resulting in placement disruptions and subsequent placement in
24 congregate care.”
25 135. DCS and DHS further abdicate their legal duty to provide care for members of
26 the General Class by leaving the decision whether children should be placed in HCTC
27 homes to the six RBHAs that operate throughout the state, rather than allowing that
28 decision to be made by the children’s Child and Family Teams (“CFTs”). Making matters
26
1 worse, the RBHAs have different processes for determining whether HCTC should be
2 provided to the children in their geographic regions. As a result, the availability of HCTC
3 turns in part on the fortuitous circumstance of where the member of the General Class
4 happens to live at the time HCTC is requested.
5 136. DCS caseworkers also fail to meet their obligation under agency policy to
6 participate in CFT meetings, including inter-agency meetings with DHS, that are a
7 prerequisite to members of the General Class receiving behavioral health services. When
8 DCS caseworkers do not join CFT meetings, essential information about a child’s needs is
9 not shared, treatment planning and referrals are held up, and services are delayed. These
10 deficiencies expose members of the General Class to an undue risk that they will not
11 receive the behavioral services they require, leading to a deterioration of the child’s
12 condition while in state foster care custody.
13 137. Remarkably, even former DES Director Carter acknowledged at an
14 October 17, 2013 meeting of the CPS Oversight Committee that DES does not collect data
15 in a way that enables the child welfare agency to show that a particular set of family
16 interventions is effective. At the same meeting, Ms. Sotomayor, then Assistant Director
17 for the former DES Division of Children, Youth and Families, agreed that it is unclear
18 whether a number of services provided by DES “are appropriate or adequate” for families.
19 138. In addition to the lack of adequate mental health services, far too many
20 children in state foster care fail to receive needed physical health care services. According
21 to the state’s Practice Improvement Case Review (“PICR”) for 2013, DCS failed to
22 properly assess and address the children’s physical health needs in a third (34%) of the
23 cases reviewed. The same review found that 22% of children who had been in foster care
24 for more than 12 months had not received a comprehensive physical health examination.
25 In addition, more than 40% of children who had been in care for less than a year did not
26 receive an examination within 30 days as required by agency policy. Based on the same
27 2013 PICR, DCS had failed to assess and provide necessary services to address the
28 children’s mental health needs in nearly one in five cases reviewed.
27
1 139. Based on the 2012 PICR, the state child welfare agency failed to meet the
2 physical health care needs of children in state foster care in 49% of the cases reviewed.
3 140. Moreover, according to the state child welfare agency’s own data, during
4 federal fiscal year 2012, 36% of children in state foster care ages three to six did not
5 receive well-care visits required under the periodicity schedule that the state is required to
6 establish under the EPSDT provisions of the federal Medicaid Act. A nearly identical
7 percentage of adolescents in foster care likewise failed to receive such required health care
8 visits. Similar failures in providing such services to these age groups were reported for
9 federal fiscal years 2009, 2010 and 2011.
10 141. In addition, according to the state’s PICR for 2013, 34% of children who had
11 been in state foster care for more than six months were found not to have had a dental
12 examination within the most recent six months. During 2012, the number of children who
13 had missed required dentist visits was nearly four in ten.
14 142. The inadequacy of the health care services provided to the General Class
15 subjects these children to harm and/or an unreasonable risk of suffering ongoing physical
16 and emotional harm and deterioration while in state foster care.
17 143. A state assumes an affirmative duty under the Fourteenth Amendment to the
18 United States Constitution to protect a child from an unreasonable risk of harm once it
19 takes that child into its legal foster care custody.
20 144. Defendant McKay directly and indirectly controls and is responsible for the
21 child welfare policies and practices of DCS. The foregoing DCS policies and practices fail
22 to satisfy its affirmative duty to protect the General Class, including the Named Plaintiffs,
23 from an unreasonable risk of physical and emotional harm. These failures are a substantial
24 factor leading to, and proximate cause of, the ongoing violation of the General Class’s
25 constitutionally protected liberty and privacy rights.
26 145. Defendant Christ directly and indirectly controls and is responsible for the
27 policies and practices regarding the provision of mental and behavioral health services by
28 DHS. The foregoing DHS policies and practices fail to satisfy its affirmative duty to
28
1 protect the General Class, including the Named Plaintiffs, from an unreasonable risk of
2 emotional harm. These failures are a substantial factor leading to, and proximate cause of,
3 the ongoing violation of the General Class’s constitutionally protected liberty and privacy
4 rights.
5 146. The foregoing policies and practices of DCS and DHS described herein
6 constitute a policy, pattern, custom and/or practice that shocks the conscience, is outside
7 the exercise of any professional judgment, and amounts to deliberate indifference to the
8 constitutionally protected rights and liberty and privacy interests of the Named Plaintiffs
9 and other members of the General Class. As a result, all members of the General Class
10 have been harmed or are being subjected to an ongoing unreasonable risk of harm, in
11 deprivation of their substantive due process rights guaranteed by the Fourteenth
12 Amendment to the United States Constitution.
13 147. These substantive due process rights include, but are not limited to: the right
14 of members of the General Class to protection from harm and unreasonable risk of harm
15 while in state foster care custody; the right to a living environment that protects the
16 physical, mental and emotional safety and well-being of the General Class; the right to
17 necessary treatment, care and services to prevent members of the General Class from
18 deteriorating or being harmed physically, psychologically or otherwise while in state foster
19 care; and the right to adequate caseworker supervision and monitoring of the General
20 Class’s safety and well-being.
21 148. As of September 30, 2014, there were 16,990 members of the General Class.
22 The General Class is sufficiently numerous to make individual joinder impracticable.
23 149. Named Plaintiffs’ First Cause of Action raises questions of fact and law that
24 are common to, and typical of, all members of the General Class. Such common questions
25 of fact include:
26 a. Whether DCS has a practice of failing to provide members of the
27 General Class with legally required medical and dental services necessary to keep
28
29
1 the General Class safe and properly cared for, and to prevent them from
2 deteriorating physically while in state foster care custody;
3 b. Whether DHS has a practice of failing to provide members of the
4 General Class with legally required mental and behavioral health services necessary
5 to keep the General Class safe and properly cared for, and to prevent them from
6 deteriorating emotionally and psychologically while in state foster care custody; and
7 c. Whether DCS has a practice of failing to coordinate and ensure that
8 the General Class are provided with the legally required mental and behavioral
9 health services to keep the General Class safe and properly cared for, and to prevent
10 them from deteriorating emotionally and psychologically while in state foster care
11 custody.
12 150. Such common questions of law include whether DCS’s and DHS’s actions and
13 inactions violate the General Class’s substantive due process rights to be free from harm
14 and an unreasonable risk of harm while in state foster care custody.
15 151. Named Plaintiffs will fairly and adequately protect the interests of the General
16 Class they seek to represent.
17 152. Named Plaintiffs and the putative General Class are represented by:
18 a. Attorneys employed by Perkins Coie LLP, an international law firm
19 with an office in Phoenix, Arizona, whose attorneys have extensive experience in
20 complex civil and public interest litigation, including class action litigation;
21 b. Attorneys employed by the Arizona Center for Law in the Public
22 Interest, a nonprofit legal organization based in Phoenix whose attorneys also have
23 extensive experience in complex civil and public interest litigation, including class
24 action litigation; and
25 c. Attorneys employed by Children’s Rights, Inc., a nonprofit legal
26 organization whose attorneys have substantial experience and expertise in child
27 welfare class actions nationally.
28
30
1 153. The attorneys and organizations listed above have investigated all claims in
2 this action and have committed sufficient resources to represent the General Class.
3 154. Each Named Plaintiff appears by a next friend, and each next friend is
4 sufficiently familiar with the facts of the child’s situation to fairly and adequately represent
5 the child’s interests in this litigation.
6 155. Defendants McKay and Christ have acted or failed to act on grounds generally
7 applicable to the General Class, necessitating declaratory and injunctive relief. Plaintiffs’
8 counsel know of no conflicts between or among members of the General Class.
9 SECOND CAUSE OF ACTION – VIOLATION OF PLAINTIFFS’ RIGHTS
10 UNDER THE EPSDT PROVISIONS OF THE MEDICAID ACT
12 157. This claim is asserted against defendants McKay, Christ and Betlach in their
13 official capacities on behalf of all members of the General Class who are eligible for
14 Medicaid (the “Medicaid Subclass”).
15 158. Medicaid is a joint federal-state program under Title XIX of the Social
16 Security Act, 42 U.S.C. § 1396, et seq., designed to provide medically necessary physical
17 and mental health care to, among others, eligible children.
18 159. States that choose to participate in the Medicaid program are reimbursed by
19 the federal government for a portion of the cost of providing Medicaid benefits. To
20 receive federal funds, states must comply with the requirements set forth in Title XIX of
21 the Social Security Act and its implementing regulations. Among those requirements,
22 states are required to develop state plans that identify the medical services available to
23 eligible beneficiaries.
24 160. Children in state foster care are eligible beneficiaries of Medicaid services
25 under 42 U.S.C. § 1396a(a)(10)(A)(i)(I).
26 161. Under 42 U.S.C. § 1396a(a)(10)(A) and 42 U.S.C. § 1396d(a)(4)(B), states are
27 required to provide EPSDT services to eligible children in state foster care. The required
28 screening services are set forth in 42 U.S.C. § 1396d(r)(1), while §§ 1396a(a)(43)(C) and
31
1 1396d(r)(5) require states to provide necessary health care, diagnostic services and treatment
2 to correct or ameliorate defects or physical and mental illnesses and conditions discovered
3 by those screening services.
4 162. Under 42 U.S.C. § 1396d(r)(1)(A)(i) and 42 C.F.R. § 441.58, states are
5 required to establish periodicity schedules setting forth when the screening services
6 required under the Medicaid Act must be provided.
7 163. Moreover, under 42 U.S.C. § 1396a(a)(8) and 42 C.F.R. § 435.930(a), states
8 must provide EPSDT services with reasonable promptness.
9 164. The policy underlying the EPSDT mandate is to prevent illness, as well as to
10 ensure that health problems are comprehensively diagnosed and then treated as soon as
11 they are detected, before they become more complex and their treatment more costly.
12 165. Pursuant to a contract with AHCCCS, DCS serves as the statewide
13 administrator responsible for the provision of physical, dental, vision and hearing health
14 care services, including screening, diagnostic and treatment services, to members of the
15 Medicaid Subclass. DCS and AHCCCS are legally obligated to ensure that members of
16 the Medicaid Subclass receive such medical services. DCS provides such medical services
17 through CMDP.
18 166. DCS also determines the Medicaid eligibility of every child in state foster care
19 custody.
20 167. Pursuant to a contract with AHCCCS, DHS serves as the statewide
21 administrator responsible for the provision of mental and behavioral health care services,
22 including screening, diagnostic and treatment services, to members of the Medicaid
23 Subclass. DHS and AHCCCS are legally obligated to ensure that members of the
24 Medicaid Subclass receive such medical services. DHS provides such services through
25 BHS, which, in turn, delivers these services through contracts with RBHAs across the
26 state.
27 168. Under Arizona’s EPSDT Periodicity Schedule, DCS is required to provide
28 annual physical examinations to members of the Medicaid Subclass who are age three and
32
1 older, and more frequent physical examinations to members of the Medicaid Subclass
2 under age three. The state’s Periodicity Schedule further requires DCS to provide annual
3 vision screenings to members of the Medicaid Subclass ages 4-6, 8, 10 and 12 years old,
4 and semi-annual dental examinations to members of the Medicaid Subclass who are six
5 months of age or older.
6 169. DCS’s Policy and Procedure Manual further provides that it is the
7 responsibility of the DCS foster care caseworker to ensure that a child entering foster care
8 be given a complete medical examination that meets EPSDT requirements within 30 days
9 after initial placement in out-of-home care.
10 170. As for mental and behavioral health services, DHS is required under Arizona’s
11 EPSDT Periodicity Schedule to provide members of the Medicaid Subclass age three and
12 older with annual psychosocial/behavioral assessments. For members of the Medicaid
13 Subclass under the age of three, the Periodicity Schedule requires DHS to provide more
14 frequent psychosocial/behavioral assessments.
15 171. Under DHS Policy, DHS is also responsible for conducting an Urgent
16 Response assessment of every child within 24 hours of removal from his or her home to
17 detect both initial and delayed effects of trauma.
18 172. AHCCCS is charged under state statutes and the federal Medicaid Act with
19 the responsibility to administer and supervise Arizona’s Medicaid program.
20 Notwithstanding its contracts with DCS and DHS, AHCCCS has the authority and
21 responsibility to determine the state’s Medicaid eligibility policies and criteria, its service
22 coverage and its payment policies. AHCCCS is also responsible for ensuring the state’s
23 compliance with federal Medicaid requirements, including the provision of EPSDT
24 services, and for supervising the compliance of DCS and DHS under their contacts with
25 AHCCCS.
26 173. Defendants McKay, Christ and Betlach have a practice of failing to provide
27 members of the Medicaid Subclass with the screening, diagnostic and treatment services
28
33
1 required under the EPSDT provisions of the Medicaid Act, in violation of 42 U.S.C. §§
2 1396a(a)(10)(A)(i)(I), 1396a(a)(43)(C), 1396d(a)(4)(B) and 1396d(r).
3 174. Defendants McKay, Christ and Betlach also have a practice of failing to provide
4 such services with reasonable promptness, in violation of 42 U.S.C. § 1396a(a)(8) and 42
5 C.F.R. § 435.930(a).
6 175. The foregoing policies and practices of defendant McKay, who directly and
7 indirectly controls and is responsible for the policies and practices of DCS, defendant
8 Christ, who directly and indirectly controls and is responsible for the policies and practices
9 of DHS, and defendant Betlach, who is responsible for supervising the compliance of DCS
10 and DHS under their contracts with AHCCCS and ensuring their compliance with federal
11 law, violate the rights of Named Plaintiffs and the Medicaid Subclass under the Medicaid
12 Act.
13 176. As of September 30, 2014, there were over 10,000 members of the Medicaid
14 Subclass. The Medicaid Subclass is sufficiently numerous to make individual joinder
15 impracticable.
16 177. Named Plaintiffs’ Second Cause of Action raises questions of fact and law that
17 are common to, and typical of, all members of the Medicaid Subclass. Such common
18 questions of fact include:
19 a. Whether DCS has a practice of failing to provide members of the
20 Medicaid Subclass with screening services that comply with the state’s Periodicity
21 Schedule;
22 b. Whether DCS has a practice of failing to provide members of the
23 Medicaid Subclass with medically necessary diagnostic and treatment services;
24 c. Whether DHS has a practice of failing to provide members of the
25 Medicaid Class with screening services that comply with the state’s Periodicity
26 Schedule; and
27 d. Whether DHS has a practice of failing to provide members of the
28 Medicaid Subclass with medically necessary diagnostic and treatment services.
34
1 178. Such common questions of law include whether DCS’s, DHS’s and
2 AHCCCS’s actions and inactions violate the Medicaid Subclass’s rights under the EPSDT
3 provisions of the federal Medicaid Act.
4 179. Named Plaintiffs will fairly and adequately protect the interests of the
5 Medicaid Subclass they seek to represent.
6 180. Named Plaintiffs and the putative Medicaid Subclass are represented by:
18 this action and have committed sufficient resources to represent the Medicaid Subclass.
22 183. Defendants McKay, Christ and Betlach have acted or failed to act on grounds
23 generally applicable to the Medicaid Subclass, necessitating declaratory and injunctive
24 relief. According to Director Betlach’s May 17, 2015 motion to intervene in this ac tion, it
25 is not possible to enter the relief sought in this Cause of Action without AHCCCS as a
26 defendant. Plaintiffs’ counsel know of no conflicts between or among members of the
27 Medicaid Subclass.
28
35
1 THIRD CAUSE OF ACTION – VIOLATION OF PLAINTIFFS’ SUBSTANTIVE

DUE PROCESS RIGHTS UNDER THE U.S. CONSTITUTION
2
4 185. This claim is asserted on behalf of the General Class against defendant McKay
5 in his official capacity.
6 Members of the General Class Are Not Receiving Timely Investigations of

Reports That They Have Been Maltreated in State Foster Care Custody.
7
8 186. In late 2013, it was publicly disclosed for the first time that the state child
9 welfare agency had failed to investigate 6,600 reports of alleged child abuse and neglect
10 between 2009 and 2013, choosing instead to simply set those reports aside. In July 2014,
11 it was disclosed that in another 14,000 cases, no documentation had been entered in the
12 child’s or family’s case file for 60 days or more through April 2014.
13 187. While the legislation passed on May 29, 2014 attempts to address those
14 enormous backlogs, DCS’s failure to complete child maltreatment investigations in a
15 timely manner is not limited to those 20,600 reports and cases. In fact, DCS is also failing
16 to initiate and complete investigations in a timely manner of reports that children have
17 been abused or neglected while in state foster care. DES’s own consultants acknowledged
18 in 2012 that foster care workers “often have a backlog” of new maltreatment reports
19 involving children in state foster custody.
20 188. According to the state child welfare agency’s own data, during federal fiscal
21 year 2012, the state child welfare agency failed to initiate investigations into 36% of all
22 reports that children in state foster care custody had been abused or neglected, within the
23 time frames required under state policy. During the six-month period from October 1, 2012
24 through March 31, 2013, 54% of all investigations involving children in state foster care
25 were initiated late.
26 189. State law and agency policy further requires that the outcomes of child
27 maltreatment investigations be entered into the State’s child welfare information database
28 within 45 days and that investigations be closed within 60 days. However, according to
36
1 state data, during the six-month period from October 1, 2012 to March 31, 2013, the state
2 child welfare agency failed to meet this 60-day deadline in the large majority of
3 investigations involving children already in state foster care, regardless of the level of risk
4 to which members of the General Class were exposed. In fact, 72% of investigations into
5 high risk reports involving a present danger to children in state foster care were still not
6 closed after 60 days; 73% of investigations into reports involving an impending danger to
7 children in care were not closed in a timely manner; 72% of investigations into reports that
8 children in care had been abused or neglected within the past 30 days were not closed
9 within the required period; and 78% of investigations were not closed within the required
10 timeframe where the reports involved children in state foster care who had been abused or
11 neglected more than 30 days prior, the date of the last occurrence of abuse or neglect was
12 unknown, or the child was exposed to an unreasonable risk of harm.
13 190. These widespread delays in initiating and completing investigations into
14 reported child abuse and neglect subject members of the General Class to an unreasonable
15 risk of physical and emotional harm while in state foster care.
21 to satisfy its affirmative duty to protect the General Class, including the Named Plaintiffs,
22 from an unreasonable risk of physical and emotional harm. These failures are a substantial
23 factor leading to, and proximate cause of, the ongoing violation of the General Class’s
24 constitutionally protected liberty and privacy rights.
25 193. The foregoing policies and practices of DCS described herein constitute a
26 policy, pattern, custom and/or practice that shocks the conscience, is outside the exercise
27 of any professional judgment, and amounts to deliberate indifference to the constitutionally
28 protected rights and liberty and privacy interests of the Named Plaintiffs and other
37
1 members of the General Class. As a result, all members of the General Class have been
2 harmed or are being subjected to an ongoing unreasonable risk of harm, in deprivation of
3 their substantive due process rights guaranteed by the Fourteenth Amendment to the
4 United States Constitution.
5 194. These substantive due process rights include, but are not limited to: the right of
6 members of the General Class to protection from harm and unreasonable risk of harm
7 while in state foster care custody; the right to a living environment that protects the
8 physical, mental and emotional safety and well-being of the General Class; the right to
9 necessary treatment, care and services to prevent members of the General Class from
10 deteriorating or being harmed physically, psychologically or otherwise while in state foster
11 care; and the right to adequate caseworker supervision and monitoring of the General
12 Class’s safety and well-being.
13 195. As of September 30, 2014, there were 16,990 members of the General Class.
14 The General Class is sufficiently numerous to make individual joinder impracticable.
15 196. Named Plaintiffs’ Third Cause of Action raises questions of fact and law that
16 are common to, and typical of, all members of the General Class. Such common questions
17 of fact include whether DCS has a practice of failing to conduct timely investigations into
18 reports that members of the General Class have been abused or neglected while in state
19 foster care custody.
20 197. Such common questions of law include whether DCS’s actions and inactions
21 violate the General Class’s substantive due process rights to be free from harm and an
22 unreasonable risk of harm while in state foster care custody.
23 198. Named Plaintiffs will fairly and adequately protect the interests of the General
24 Class they seek to represent.
25 199. Named Plaintiffs and the putative General Class are represented by:
38

9 this action and have committed sufficient resources to represent the General Class.
13 202. Defendant McKay has acted or failed to act on grounds generally applicable to
14 the General Class, necessitating declaratory and injunctive relief. Plaintiffs’ counsel know
15 of no conflicts between or among members of the General Class.
16 FOURTH CAUSE OF ACTION – VIOLATION OF PLAINTIFFS’ SUBSTANTIVE
17 DUE PROCESS RIGHTS UNDER THE U.S. CONSTITUTION
19 204. This claim is asserted against Defendant McKay in his official capacity on
20 behalf of all members of the General Class, except those children who are or will be in a
21 kinship placement (the “Non-Kinship Subclass”).
22 A. The Non-Kinship Subclass Suffers from a Severe Shortage of Foster
23 Homes.
24 205. The state child welfare agency has failed to provide members of the Non-
25 Kinship Subclass with an adequate number and array of foster care placements. The
26 severe shortage of foster care placements frequently results in the state child welfare
27 agency placing members of the Non-Kinship Subclass in the first available bed, rather than
28 selecting placements based on the children’s needs.
39
1 206. While Arizona’s population of children in out-of-home care has grown by 56%
2 from September 2009 to March 2014, the number of Arizona foster families has only
3 increased by 9%, and the percentage of children placed in licensed foster homes has
4 decreased by 9%, during the same time period.
5 207. As of September 30, 2014, there were 9,418 children in state foster care who
6 were not placed with relatives or in trial home reunification settings. Nevertheless, the
7 state child welfare agency reported that it had licensed only 4,397 foster homes to accept
8 children in state foster care. Moreover, these foster homes provided only 5,669 available
9 spaces that could potentially match the needs of the children in DCS’s custody. Even
10 assuming that each of these spaces matched the needs of the Non-Kinship Class, 3,749
11 class members would still be without a foster home.
12 208. A spokeswoman for DCS acknowledged in July 2014 that the department
13 “desperately needs more foster families to care for the increased number of children in out -
14 of-home care.”
15 209. A recent DCS report stated that “[h]omes are needed for children of all ages,
16 however the most significant shortages of homes are for teens, sibling groups, and children
17 who have complex medical needs.” The agency admits that “[t]here is a significant need
18 for additional foster and adoptive homes in all areas of Arizona.”
19 210. According to a recent audit by the Arizona Auditor General, the state child
20 welfare agency “has not adequately implemented” performance-based contracting in the
21 contracts it has entered into with private child placing agencies to recruit foster parents,
22 identify and arrange child placement options, and supervise and monitor licensed foster
23 parents. The audit also found that the state child welfare agency has not developed
24 policies and procedures for monitoring the performance measures in its contracts, has not
25 used performance measure data to assess contractor performance, and has not adequately
26 designed the contracts to incentivize performance.
27 211. In addition to the inadequate recruiting of new foster homes, a 2012 survey
28 conducted by Arizona State University noted that programs and financial benefits available
40
1 to foster families have been drastically cut in recent years due to severe budget constraints.
2 For example, in 2009, the state cut foster family reimbursement rates and allowances for
3 clothing.
4 212. The scarcity of foster homes in Arizona is a well-known problem. In 2012,
5 The Arizona Republic reported that “[t]he state is in dire need of families to care for
6 children removed from their homes because of suspected abuse or neglect. But families
7 leave the foster care system faster than new ones come in. Many who leave say it’s not
8 necessarily the children who have caused them to turn in their license but their frustration
9 with the system’s inability to help them.”
10 213. Former DCS director Charles Flanagan has also acknowledged to members of
11 the state legislature that there are many instances when children have slept in agency
12 offices because the agency did not have a placement for them.
13 214. In fact, according to a recent press account, over just a six-day span from
14 September 28 to October 4, 2014, 36 members of the Non-Kinship Subclass spent at least
15 one night in DCS office buildings in Maricopa and Pima counties. Of those 36 children,
16 10 were between 2 and 5 years old, 11 were between 6 and 12 years old, and 15 were
17 between 13 and 18 years old. According to Gene Burns, who supervises DCS after-hours
18 units, “[i]n the 17 years [he has] been here, the biggest shock to [him] is when [DCS]
19 bought cribs” for the young children sleeping at DCS’s offices. As he acknowledged,
20 “[t]his is not the place to put a kid.”
21 B. Because of the Shortage of Foster Homes, Members of the Non-Kinship
22 Subclass Are Frequently Placed Far from Their Home Communities.
23 215. DCS’s failure to maintain an adequate array of foster homes harms members
24 of the Non-Kinship Subclass by causing them to be placed, or putting them at an
25 unreasonable risk of being placed, far from their home communities. Such placements
26 disconnect members of the Non-Kinship Subclass from family, friends, and neighbors, and
27 frequently lead to highly disruptive changes in schooling.
28
41
1 216. Only 31% of all children in foster care as of September 30, 2012, for whom
2 removal and current zip code information was available, were placed within the same zip
3 code as their homes. Moreover, nearly half of these children were placed outside their
4 home city.
5 217. Consultants retained by DES reported that in 2011, almost 60% of children in
6 state foster care were placed over an hour from their homes. As the consultant reco gnized,
7 “[t]his makes parent visits and services difficult and contributes to Ongoing staff driving
8 more hours and spending more time away from their other cases.”
9 C. Because of the Shortage of Foster Homes, Members of the Non-Kinship
10 Subclass Are Frequently Separated from Their Siblings.
11 218. For children entering state foster care, siblings can serve as a crucial buffer
12 against the emotional upheaval of being separated from their parents. Sibling relationships
13 can also promote resilience as children navigate the trauma of removal. In recognition of
14 the importance of maintaining sibling relationships, federal law requires states to make
15 reasonable efforts to place siblings together, unless contrary to a sibling’s safety or well -
16 being – a requirement echoed in Arizona state policy.
17 219. DCS’s failure to maintain an adequate array of foster homes harms members
18 of the Non-Kinship Subclass by causing them to be separated, or putting them at an
19 unreasonable risk of being separated, from their siblings. As of September 30, 2013, the
20 state child welfare agency failed to place all siblings together in 35% of cases, and failed to
21 place at least two siblings together in 24% of cases. Based on information the state child
22 welfare agency submitted to the federal government in 2012, in nearly 40% of cases when
23 at least two siblings entered out-of-home care, the state child welfare agency failed to
24 place them together. The Sstate child welfare agency’s performance was nearly as bad
25 every year from 2008 through 2011. A DES official acknowledged in 2012 that it had
26 become more difficult to place siblings in the same home because of the shortage of foster
27 families and because more children stay in care longer.
28
42
6 to satisfy its affirmative duty to protect the Non-Kinship Subclass, including the Named
7 Plaintiffs, from an unreasonable risk of physical and emotional harm. These failures are a
8 substantial factor leading to, and proximate cause of, the ongoing violation of the Non-
9 Kinship Subclass’s constitutionally protected liberty and privacy rights.
10 222. The foregoing policies and practices of DCS described herein constitute a
11 policy, pattern, custom and/or practice that shocks the conscience, is outside the exercise
12 of any professional judgment, and amounts to deliberate indifference to the constitutionally
13 protected rights and liberty and privacy interests of the Named Plaintiffs and other
14 members of the Non-Kinship Subclass. As a result, all members of the Non-Kinship
15 Subclass have been harmed or are being subjected to an ongoing unreasonable risk of
16 harm, in deprivation of their substantive due process rights guaranteed by the Fourteenth
17 Amendment to the United States Constitution.
18 223. These substantive due process rights include, but are not limited to: the right
19 of members of the Non-Kinship Subclass to protection from harm and unreasonable risk of
20 harm while in state foster care custody; the right to a living environment that protects the
21 physical, mental and emotional safety and well-being of the Non-Kinship Subclass; the
22 right to necessary treatment, care and services to prevent members of the Non-Kinship
23 Subclass from deteriorating or being harmed physically, psychologically or otherwise
24 while in state foster care; and the right to adequate caseworker supervision and monitoring
25 of the Non-Kinship Subclass’s safety and well-being.
26 224. As of September 30, 2014, there were 9,454 members of the Non-Kinship
27 Subclass. The Non-Kinship Subclass is sufficiently numerous to make individual joinder
28 impracticable.
43
1 225. Named Plaintiffs’ Fourth Cause of Action raises questions of fact and law that
2 are common to, and typical of, all members of the Non-Kinship Subclass. Such common
4 a. Whether DCS maintains an adequate number and array of foster home
5 placements for members of the Non-Kinship Subclass; and
6 b. Whether a shortage of foster homes subjects members of the Non-
7 Kinship Subclass to an unreasonable risk of being placed far from their families,
8 schools and home communities.
10 violate the Non-Kinship Subclass’s substantive due process rights to be free from harm
11 and an unreasonable risk of harm while in state foster care custody.
12 227. Named Plaintiffs will fairly and adequately protect the interests of the Non-
13 Kinship Subclass they seek to represent.
14 228. Named Plaintiffs and the putative Non-Kinship Subclass are represented by:
26 this action and have committed sufficient resources to represent the Non-Kinship Subclass.
27
28
44
5 the Non-Kinship Subclass, necessitating declaratory and injunctive relief. Plaintiffs’
6 counsel know of no conflicts between or among members of the Non-Kinship Subclass.
7 FIFTH CAUSE OF ACTION – VIOLATION OF PLAINTIFFS’ RIGHTS TO
8 FAMILY INTEGRITY UNDER THE U.S. CONSTITUTION
10 233. This claim is asserted against Defendant McKay in his official capacity on
11 behalf of all members of the General Class who have been assigned a permanency goal of
12 family reunification (the “Reunification Subclass”).
13 234. Despite the fact that over 50% of children in state foster care have a
14 permanency goal of family reunification, the state child welfare agency is failing to
15 preserve family relationships after children are removed from their homes.
16 235. One of the principal ways that states preserve the family relationships of
17 children in foster care is to place siblings together when they are removed from their
18 homes, as required under federal and state law. In 2012, however, Arizona failed to place
19 siblings together in nearly 40% of cases when at least two siblings entered out-of-home
20 care. As of September 30, 2013, the state child welfare agency failed to place all siblings
21 together in 35% of cases, and failed to place at least two siblings together in 24% of cases.
22 236. Moreover, as alleged in paragraphs 215-217 above, the state child welfare
23 agency routinely places children in its care far from their home communities, knowingly
24 interfering with their ability to maintain connections with their families.
25 237. Another way that states preserve the family relationships of children in foster
26 care is to place such children, when appropriate, with one or both biological parents on a
27 “trial reunification” basis, while maintaining legal custody over the child. Arizona,
28 however, systematically fails to do so. As of September 30, 2014, only 0.21% of children
45
1 in state foster care custody (36 out of 16,990 children) were placed with their parents on a
2 trial reunification basis.
3 238. As of September 30, 2013, only 0.29% of children in out-of-home care (23 of
4 the 7,875 children) who had a permanency goal of family reunification were in a trial
5 reunification placement.
6 239. Similarly, only 1.6% of the children in care who exited to reunification during
7 federal fiscal year 2012 (60 out of 3,684) were in a trial home visit placement at the time
8 of exit. The national average was 37.5%. Moreover, only 0.5% of children in custody
9 during federal fiscal year 2012 (97 out of 21,267) had a most recent placement type of trial
10 home visit. The national average was 11.0%.
11 240. When children in state foster care custody are not placed with their families on
12 a trial reunification basis, DCS is under a legal duty to coordinate contact between these
13 children and their biological parents, as well as any siblings from whom the child may
14 have been separated when taken into custody. The state child welfare agency has
15 recognized that “there is a strong correlation between consistent and timely visitation and
16 positive outcomes for children who have been removed from their home. Regular parent-
17 child visitation, along with CPS Specialists’ visits with the child, are both associated with
18 achieving permanency and other indicators of child well-being.”
19 241. For 2012, however, the state child welfare agency reported that barely half
20 (51%) of children in out-of-home care whose cases were reviewed as part of the child
21 welfare agency’s PICR had visits with their parents and siblings at a frequency consistent
22 with the child’s safety and best interests. During calendar year 2013, a similarly low
23 percentage of children (56%) whose cases were reviewed in connection with the PICR had
24 adequate visits with parents and siblings.
25 242. The state child welfare agency’s poor performance in coordinating family
26 visits is no surprise given the long wait lists that children in foster care face before being
27 provided with transportation to and from, and supervision of, family visits. As of October
28 2013, there were 475 families waiting for such visitation services. Remarkably, the state
46
1 child welfare agency does not even track how long families have been waiting for those
2 services.
3 243. The state child welfare agency further impairs family relationships by
4 routinely failing to comply with its obligation to make monthly contact with the biological
5 parents of children in state foster care. During the six-month period from April 1, 2014
6 through September 30, 2014, 1,213 out of 2,528 (48.0% of) parents of children in foster
7 care with a case plan goal of reunification did not receive required visits from a state child
8 welfare caseworker.
9 244. Likewise, during the six-month period from October 1, 2013 through
10 March 31, 2014, 1,152 out of 2,496 (46.2% of) parents of children in foster care with a
11 case plan goal of reunification did not receive required visits from a state caseworker.
12 245. DCS recently reported that during 2013, caseworkers made concerted efforts to
13 have adequate contact with mothers in only 36% of cases reviewed, and with fathers in
14 only 18% of cases reviewed.
15 246. Not surprisingly, given the state child welfare agency’s failure to make
16 adequate contact with the biological parents of children in foster care, the agency also
17 systematically fails to involve those parents in their children’s case planning. During
18 2013, the state child welfare agency made concerted efforts to actively involve the child’s
19 mother in case planning in only slightly more than half (54%) of cases reviewed, and to
20 involve the father in little more than a third (36%) of cases. According to DCS, “[c]ase
21 plans are not consistently developed and reassessed within required timeframes.”
22 247. An all too predictable result of the state child welfare agency’s failure to
23 preserve family relationships is that far too few members of the Reunification Subclass are
24 reunified with their families. Moreover, when reunification does occur, it takes far too
25 long.
26 248. The amount of time that members of the Reunification Class spend in out-of-
27 home care before being reunified with their families has also increased over time.
28 According to data prepared for the state child welfare agency, the percentage of children
47
1 who reunified within 90 days decreased from 30% for children who entered state foster
2 care in 2008 to 18% for children who entered such care in 2012; the percentage of children
3 who reunified within six months fell from 35% for the 2008 entry group to 23% for the
4 2012 entry group; and the percentage of children who reunified within one year fell from
5 44% for the 2008 entry group to 37% for the 2012 entry group.
6 249. DCS is aware of its poor performance. According to a 2014 agency report,
7 “[c]ompared to prior years, children are now less likely to exit to reunification, and they
8 experience longer lengths of stay before reunifying.”
9 250. The foregoing DCS practices interfere with the right to family integrity held by
10 members of the Reunification Subclass, and subject them to emotional harm and an
11 unreasonable risk of emotional harm.
13 policies and practices of DCS. The foregoing policies and practices fail to satisfy DCS’s
14 affirmative duty to protect the welfare of the Reunification Subclass, which failure is a
15 substantial factor leading to, and a proximate cause of, the violation of the constitutionally
16 protected liberty interests, privacy interests and associational rights of all members of the
17 Reunification Subclass.
18 252. The foregoing policies and practices of DCS amount to a policy, pattern,
19 custom and/or practice that is outside the exercise of any professional judgment and
20 amounts to deliberate indifference to the Reunification Subclass’s constitutional rights.
21 As a result, all members of the Reunification Subclass are being deprived, or are at
22 unreasonable risk of being deprived, of their liberty interests, privacy interests and
23 associational rights conferred on them by the First, Ninth, and Fourteenth Amendment to
24 the United States Constitution not to be deprived of child-parent or child-sibling family
25 relationships.
26 253. The Reunification Subclass has thousands of members and is therefore
27 sufficiently numerous to make individual joinder impracticable.
28
48
1 254. Named Plaintiffs’ Fifth Cause of Action raises questions of fact and law that
2 are common to, and typical of, all members of the Reunification Subclass. Such common
4 a. Whether DCS engages in a practice of placing members of the
5 Reunification Subclass far from their home communities;
6 b. Whether DCS engages in a practice of failing to place members of the
7 Reunification Subclass in trial home reunification settings;
8 c. Whether DCS engages in a practice of failing to coordinate contact
9 between members of the Reunification Class and their biological families;
10 d. Whether DCS engages in a practice of failing to make required
11 monthly contact with the biological parents of members of the Reunification
12 Subclass; and
13 e. Whether DCS engages in a practice of failing to involve the biological
14 parents of members of the Reunification Subclass in the case planning of those
15 children.
17 violate the Reunification Subclass’s rights to family integrity, guaranteed by the First,
18 Ninth, and Fourteenth Amendments to the United States Constitution.
19 256. Named Plaintiffs will fairly and adequately protect the interests of the
20 Reunification Subclass they seek to represent.
21 257. Named Plaintiffs and the putative Reunification Subclass are represented by:
49

5 this action and have committed sufficient resources to represent the Reunification
6 Subclass.
11 the Reunification Subclass, necessitating declaratory and injunctive relief. Plaintiffs’
12 counsel know of no conflicts between or among members of the Reunification Subclass.
13 PRAYER FOR RELIEF
14 WHEREFORE, the Named Plaintiffs respectfully request that this Court:
15 A. Assert jurisdiction over this action;
16 B. Order that this action be maintained as a class action pursuant to Rule 23(b)(2),
17 Fed. R. Civ. P.;
18 C. Declare unconstitutional and unlawful pursuant to Rule 57, Fed. R. Civ. P.:
19 1. DCS’s and DHS’s violation of plaintiffs’ substantive rights to be free
20 from harm and unreasonable risk of harm under the Due Process Clause of the
21 Fourteenth Amendment to the United States Constitution;
22 2. DCS’s violation of the Reunification Subclass’s rights to family
23 integrity under the First, Ninth, and Fourteenth Amendments to the United States
24 Constitution;
25 3. DCS’s, DHS’s and AHCCCS’s violation of plaintiffs’ rights under 42
26 U.S.C. §§ 1396a(a)(8), 1396a(a)(10)(A)(i)(I), 1396a(a)(43)(C), 1396d(a)(4)(B) and
27 1396d(r);
28
50
1 D. Permanently enjoin DCS, DHS and AHCCCS from subjecting plaintiffs to

2 practices that violate their rights;
3 E. Order appropriate remedial relief to ensure DCS’s, DHS’s and AHCCCS’s
4 future compliance with their legal obligations to plaintiffs, including, but not limited to, the
5 following:
6 1. Health Care Services Provided to Children in State Foster Care.
7 DCS and DHS shall establish and implement practices to ensure that all members of
8 the General Class receive the physical, mental and behavioral health services to
9 which they are entitled under the federal substantive Due Process Clause. Likewise,
10 DCS, DHS and AHCCCS shall establish and implement practices to ensure that all
11 members of the Medicaid Subclass receive the physical, mental and behavioral
12 health services to which they are entitled under the EPSDT provisions of the federal
13 Medicaid Act.
14 2. Availability of Necessary Resources for the Placement of
15 Children. DCS shall establish and implement practices to ensure a minimally
16 adequate capacity and array of placements to meet the placement needs of the Non-
17 Kinship Class, including foster and HCTC homes.
18 3. Family Contact and Visitation. DCS shall establish and implement
19 practices providing for minimally adequate visitation between members of the
20 Reunification Subclass and their biological parents and siblings. DCS shall also
21 establish and implement practices to adequately provide for siblings in the
22 Reunification Subclass to be placed together in foster care.
23 4. Caseworker Investigations. DCS shall establish and implement
24 practices providing for minimally adequate investigations into reports that members
25 of the General Class have been abused or neglected.
26 5. Parent-Caseworker Contacts. DCS shall establish and implement
27 practices providing for minimally adequate caseworker visits with the biological
28
51
1 parents of members of the Reunification Subclass and for the involvement of such
2 parents in the case planning of members of the Reunification Subclass.
3 6. Monitoring/Enforcement. The provisions of the Court order entered
4 pursuant to Fed. R. Civ. P. 65(d) shall be monitored by a neutral expert monitor
5 appointed by the Court. In addition, the Court shall have continuing jurisdiction to
6 oversee compliance with that order;
7 F. Award to the Named Plaintiffs the reasonable costs and expenses incurred in
8 the prosecution of this action, including reasonable attorneys’ fees, pursuant to 28 U.S.C.
9 § 1920 and 42 U.S.C. § 1988, and Fed. R. of Civ. P. 23(e) and (h); and
10 G. Grant such other and further equitable relief as the Court deems just,
11 necessary and proper to protect Named Plaintiffs, the General Class, the Medicaid
12 Subclass, the Non-Kinship Subclass and the Reunification Subclass from further harm and
13 unreasonable risk of harm by DCS, DHS and AHCCCS.
14
15 Respectfully submitted this 8 th day of June, 2015.
16 CHILDREN’S RIGHTS, INC.
17 By s/ William Kapell_____________
18 William Kapell
Julia L. Davis
19 Rachel B. Nili
20 Adriana T. Luciano
330 Seventh Avenue, Fourth Floor
21 New York, New York 10001
22
P ERKINS COIE LLP
23 Shane Swindle
24 2901 N. Central Avenue, Suite 2000
Phoenix, Arizona 85012-2788
25
ARIZONA CENTER FOR LAW IN THE
26
P UBLIC INTEREST
27 Anne C. Ronan
28 Timothy M. Hogan
52
1 514 West Roosevelt Street

Phoenix, Arizona 85003
2
Attorneys for Plaintiffs
3
4
5
6
7
CERTIFICATE OF SERVICE
8
9 I hereby certify that on June 8, 2015, I electronically transmitted the attached
10 document to the Clerk's Office using the CM/ECF System for filing and transmittal of a
11 Notice of Electronic Filing to the following CM/ECF registrants:
12
David Daniel Weinzweig
13 david.weinzweig@azag.gov
14 Robert Lawrence Ellman
robert.ellman@azag.gov
15 OFFICE OF THE ATTORNEY GENERAL
1275 West Washington Street
16 Phoenix, Arizona 85007-2997
17
Daniel P. Struck
18 dstruck@swlfirm.com
19 Kathleen L. Wieneke
kwieneke@swlfirm.com
20 STRUCK WIENEKE & LOVE PLC
3100 West Ray Road, Suite 300
21 Chandler, Arizona 85226
22
Logan T. Johnston
23 ltjohnston@live.com
JOHNSTON LAW OFFICES, P.L.C.
24
1402 E. Mescal Street
25 Phoenix, Arizona 85020
Telephone: (602) 452-0615
26
27 /s/ William Kapell .
28
53
EXHIBIT B
New York Times - Gov. Jan

Brewer Overhauls Child
Welfare System
Gov. Jan Brewer of Arizona Overhauls Child Welfare System - The New York Times 12#40 PM,1/2/18,1/2/18, 12#40 PM
https://nyti.ms/1hkFcv7
U.S.
Gov. Jan Brewer of Arizona Overhauls

Child Welfare System
By FERNANDA SANTOS JAN. 13, 2014
PHOENIX — Gov. Jan Brewer abolished Arizona’s beleaguered Child Protective

Services on Monday, immediately transferring the task of safeguarding abused and
neglected children to a new cabinet-level division over which she will have direct
oversight.
The move, unveiled at the governor’s State of the State address, is part of an
overhaul aimed at fixing the problems that have plagued the state’s child welfare
system for years, though none of them quite like last month’s revelation that more
than 6,500 complaints of abuse received by the agency’s hotline had been shelved
before any investigation.
Ms. Brewer has been under intense pressure from child welfare advocates, as
well as legislators from both parties, including some of her closest allies, who have
long sought the reorganization of Child Protective Services under a separate
structure. The agency operates under the largest of the state’s bureaucracies, the
Department of Economic Security, which oversees dozens of safety-net programs,
including cash assistance and health care benefits for the poor.
https://www.nytimes.com/2014/01/14/us/gov-jan-brewer-of-arizona-overhauls-child-welfare-system.html?_r=0 Page 1 of 2
Gov. Jan Brewer of Arizona Overhauls Child Welfare System - The New York Times 12#40 PM,1/2/18,1/2/18, 12#40 PM
“It is evident that our child welfare system is broken, impeded by years of
structural and operational failures,” said Ms. Brewer, a Republican.
The change requires legislative approval, but it is unlikely to face significant

opposition, given that it is the type of reorganization that most of her critics had
sought. Ms. Brewer did not say how the agency would be funded.
The new agency, the Division of Child Safety and Family Services, will handle
complaints and investigations of abuse and neglect, which have hit record numbers
since the state’s economy crashed in 2009, as well as foster care and adoption.
Charles Flanagan, director of the Arizona Department of Juvenile Corrections, will

be in charge. He leads the team of legislators, prosecutors, child welfare advocates
and state officials overseeing the inquiry into the ignored hotline complaints.
A version of this article appears in print on January 14, 2014, on Page A17 of the New York edition with the
headline: Arizona Governor Overhauls Child Welfare.
© 2018 The New York Times Company
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EXHIBIT C
In Harm’s Way: A Report on

Policy Conflict that Fails
Children and the System
Established to Protect Them
ARIZONA VOICE FOR CRIME VICTIMS 12#12 PM,1/2/18,1/2/18, 12#12 PM
ARIZONA VOICE FOR CRIME VICTIMS
IN HARM’S WAY
A REPORT ON POLICY CONFLICT THAT FAILS
CHILDREN AND THE SYSTEM ESTABLISHED TO
PROTECT THEM
Prepared For
The Honorable Richard Romley
Maricopa County Attorney
Shawn Cox, MSW

Principal Researcher
Steve Capobres
Research Editor
Steve Twist
Contributor
March 15, 2003
http://www.voiceforvictims.org/avcv_report.htm Page 1 of 91
“Liana Sandoval was already dead on September 27, 2001, when a state Child
Protective Services caseworker closed her file on the little girl, writing off
allegations as “unsubstantiated” that her mother’s boyfriend was abusing her.
The night before, Juan Velazquez confessed to police that he tied the 20-
month-old girl with heavy wire to an 18-pound chunk of concrete and sank her
body in a filthy canal.
Liana had been beaten to death, her head swollen from the blows of a grown
man’s fist.
A month earlier, her father’s family had called CPS to report Liana and her
sister, Isabella, then 3, were missing clumps of hair and covered in bruises,
marks they thought had been made by Velazquez.
CPS did not take the girls from their mother.”
From The Arizona Republic, The sad case of little Liana Sandoval, Karina Bland, January
12, 2003
DEDICATION
This Report is dedicated to the children who have died from abuse or neglect in the last five years
in Arizona and to Karina Bland, Laurie Roberts (The Arizona Republic), Mary K. Reinhart (East Valley
Tribune) and Jonathan Elias and the Investigators (ABC 15), courageous journalists who have
championed their cause:
Ramon Fausto
Vanessa Fausto
Cassandra Parker
Steven Young
Layla Molina
Adrianna Salsbury
Ali Al-Hussainy
Miguel Andrade
Brandon Garcia
Nicholas Contreraz
Michael Costell
Joseph Bernal
Michael Ridenhour
Julia Avant
Christine Tuong
Jerrad Neal
Danielle Rhem
Anthony Nored
Stacy Tapia
Joseph Gutierrez
Emily Smith
Nichomah Crowkiller
Hunter Gibbons
Gabriel Cordova
Dillon Reed
Steven Witt
Serena Baca
Devon Hayes
Vanessa Reyes
Anthony Anderson
Brisa Lopez
Jenicee Carter
Aesialeigh Roqumore
Shaun Patterson
Tyler Atchley
Alanah Phillips
Valeria Rico
Kataryne Bell
Eduardo Reyes
Alex Ramirez
Ricardo J. Rogel
Sophia Avianeda
Taylor Boldt
Aleicia Putrow
Liana Venegas
Deontae Moore
Isaac Humer
Brittney Price
Jennifer Price
Angelita Durazo
Jordan Celestine
Regina Tate
Joshua Roberts
Reina Lopaez
Benjamin Picaso
Devin Jennings
Gustavo Turrentine
Anndreah Robertson
Joseph Alva
Baby Girl Porzel
Krystal Souza
Jordan Rader
Serena Schmidt
Julia Garrett
Jesse Cope
Jilian Mendoza
Marissa Barrios
Raymond Dauberman
Steven Greathouse
Dylan Greathouse
Steven Bedwell
Male child
Female child
ACKNOWLEDGEMENTS
This study would not have been possible without the efforts of many people who freely gave of
their time and shared their insights and their passion to protect the safety of vulnerable children. To
these people and organizations we extend a very heartfelt “Thank you.” Without in anyway diminishing
the assistance of others, we especially acknowledge the tremendous help provided by Jamie Capobres,
MSW; Billy Wilda from Grandparents United for Children’s Rights; Kristine Reich, MSW, Arizona
State University, School of Social Work, for providing us very dedicated social work interns, Asha
Joseph, Amaya Evans, and Richard Woodard, all of whom helped conduct our interviews and made
terrific suggestions throughout the project; Sally Jones and her staff at Human Resource Training, Inc.;
Patti Calus, who helped review research; and the Arizona Prevention Resource Center, Arizona State
University, for giving freely of their guiding expertise; to Chief Harold Hurtt and many at the Phoenix
Police Department for their time and cooperation; and, to Dr. Katheryn Coffman and Detective Chris
Metalski for their expertise and dedication over the course of this project.
Finally, we extend our sincere thanks to the Honorable Richard M. Romley, Maricopa County
Attorney, for his passionate commitment to the cause of justice for child victims, and to his staff for
their professionalism, advocacy, and willing cooperation and assistance throughout the study.
Together, we hope to see a time when the children of Arizona will have a future safe from
criminal abuse and neglect.
TABLE OF CONTENTS
Dedication ……………………………………………………………. 2
Acknowledgements …………………………………………………....3
Table of Contents ………………………………………………………4
Introduction: Scope of Study, Methodology, and Definitions………….5
Defining Abuse and Neglect…………………………………….11
Chapter One: First Principles…………………………………………..20
Chapter Two: National Historical Overview……………………….…..28
Chapter Three: The Scope of the Problem…………………………......40
Chapter Four: Current Law……………………………………………..45
U. S. Supreme Court……………………………….…………….45
Arizona Courts…………………………………….……………..47
Statutes and Rules..........................................................................52
Chapter Five: Voices from the Field:

Comments and Field Recommendations………………………….…….70
Chapter Six: Issues and Commentary……………………….….……..129
Conclusion………………………………………………………….….160
Recommendations….…………………………………………….….....167
INTRODUCTION: SCOPE OF STUDY, METHODOLOGY, AND DEFINITONS
This report is the conclusion of a study, conducted from March 15, 2002 through January 31,
2003, of public policy issues in Arizona arising out of the criminal abuse and neglect of children, and
related substance abuse issues.[1] It provides a policy overview of the legal and social systems that are
established to protect children from criminal abuse and neglect and reports, from extensive field
interviews, on views shared by many professionals in the field.
By “system” we mean essentially the social welfare system of child removal or family
reunification, and the services attendant to these outcomes, operated mainly through the courts and the
Arizona Department of Economic Security,[2] and the parallel law enforcement system of investigation
and prosecution of abuse and neglect crimes committed against children. There are many stakeholders
engaged in, or deeply impacted by, both these efforts. First and foremost there are the children and their
parents. Doctors, nurses, health care providers, social workers, teachers, school counselors,
grandparents and other relatives, law enforcement officers, foster parents, private and faith-based
providers of services to children and families, legislators and other government officials, prosecutors,
judges, and crime victim advocates all play roles in our society’s protection of children.
These two systems, the law enforcement system and the social welfare system, acting in concert,
although at times discordantly, more often as “ships passing in the night,” are intended by current law to
work together to protect child safety, punish those who compromise it, and at the same time, try to
strengthen and reunify families in which children have been victimized.
To conduct this study we undertook the following:
1) Compiled and reviewed all Federal and Arizona laws and rules governing the protection of
children, including relevant substance abuse laws;
2) Compiled and reviewed selected case files from criminal prosecutions involving children who
have been also the subject of abuse reports to CPS;
3) Compiled and reviewed relevant literature regarding the correlation between substance abuse
and child abuse;
4) Conducted 163 interviews of people in key sectors of the system, including judges,
prosecutors, police, victim advocates, CPS workers, community service providers, foster parents,
medical doctors, nurses, and social workers;
5) Compiled and reviewed relevant case law;
6) Researched public records relating to child abuse cases;
7) Studied the laws, rules, policies, and practices which govern and define how CPS responds to
allegations of child abuse and neglect;
8) Studied the mandatory reporter laws which govern how covered professionals report
allegations of child abuse and neglect;
9) Studied law enforcement and prosecution responses to allegations of child abuse and neglect;
and
10) Compiled and reviewed relevant statistical information regarding the handling of allegations
of child abuse and neglect.
Throughout the study we were in consultation with allied professionals working through Arizona
State University’s Prevention Resource Center, as well as professionals in the field from around Arizona
and the nation. In meetings with these professionals, with representatives of the Maricopa County
Attorney’s Office, and with other organizational and community leaders in the field, we advanced and
discussed various policy reform recommendations that make-up the focus of this report. The study does
not intend to focus criticism on those working in the field; indeed, we praise the dedication of the men
and women with whom we met, men and women who work tirelessly to protect children.
Interview Process
Interviews were conducted with 163 people representing key sectors of the system. This included
judges, prosecutors, police, victim advocates, CPS workers, community service providers, foster
parents, medical doctors, nurses and social workers. The purpose for these interviews was to allow the
"voices from the field" to speak in their own words as much as possible.
In order to understand what opportunities may exist for performance improvements, the study set
out to understand how the child welfare system functions and what changes could be made for
improvement. Each person was asked a series of questions related to their understanding of the system
based on their experience and individual expertise. The questions involved the following:
1) Background information
§ Child abuse risk factors
§ Current caseloads and trends
§ Personal interests and expertise
2) Current role and issues with the child welfare system

§ What is their primary objective?
§ What is their opinion of the central purpose of the “system”?
§ How do they work together and interact with CPS?
§ What issues or barriers currently exist?
3) Recommendations
§ What should be your primary objective?
§ What should be the primary goal of the child welfare system?
§ What changes or suggestions would you make to improve child safety and protection?
In person interviews were conducted individually and in groups. The interview process involved
open-ended questions. Each participant was provided an opportunity to respond to each question. Since
some of the interviews were performed in a group setting, comments were occasionally made that were
shared unanimously. They are recorded that way.
All interview responses were captured, tabulated and presented in the tables which follow. While
uniform questions were asked to each participant, some additional questions were asked to respondents
based upon their profession to better understand their unique role and vantage point in the system. This
explains why some questions only have responses by certain professions and not all. Like-responses
have been grouped and summarized as best as possible, trying not to change or dilute the responses that
were given. Those comments that were shared by many respondents are identified as one comment and
indicated by an asterisk (*). What is interesting and noteworthy is how often they do appear.
As stated earlier, the purpose and scope of this study was not to pursue an exhaustive academic
analysis of the child welfare system. There is already a wealth of such reports. Rather the approach
was to search for and find a venue that allowed a diversity of voices to be heard. The 163 field
interviews do not purport to represent a statistically valid sample of the professional fields they survey.
Nonetheless, the surveys have reached deep into the community. It is the hope of this report that this
venue of voices will prove to be a fruitful exercise. A summary of the 163 interviews conducted from
March 1, 2002 to January 15, 2003 is provided.
Neither was the study designed or intended to be an examination of CPS or the County Attorney’s
Office. The study identifies policy conflicts which arise from a tension and at times an inherent
inconsistency in the goals of protecting child safety and reunifying families.
In Chapter One we offer a return to basic principles of American government as the starting point
to analyze our policy regarding criminally abused and neglected children. First among them is the
principle that each child is “endowed” with “unalienable rights.”
In Chapter Two we provide a historical overview and trace the evolving, and at times regressing,
standards of treatment for abused and neglected children. We report on the recent legislative history in
this long drama and observe the fundamental tension in the present policy goals of protecting the
safety of the child and at the same time reunifying children into abusive families.
In Chapter Three we discuss the scope of the problem through the use of reported statistics. The
study confirms the enormous, and under-reported, extent of the problem of child abuse and neglect. It
raises questions about the rate of substantiated child abuse and neglect cases in Arizona.
Chapter Four offers an overview of current law, including state and federal statutory law, rules,
and case law.
Chapter Five reports on the “voices from the field,” and summarizes extensively the views and
recommendations of 163 professionals who were interviewed as part of the study.
Chapter Six raises issues, and provides commentary.
Throughout, the study offers a view of critical issues in hopes of informing the current debate
over how to create a system which most people passionately hope will rise to meet the challenge and the
promise of its name…child protective services.
Defining Abuse and Neglect

Perhaps the first sign that something is amiss in our public policy regarding child abuse and
neglect is the difficulty we seem to have of defining just exactly what it is. It is possible to find
definitions of child abuse and neglect in the literature dating back decades.[3]
Despite this there remains widespread confusion over whether child abuse is a crime (which it is),
requiring a response by a police officer and a prosecutor (which in most cases does not happen), or a
civil “family” matter (which it also is), requiring a social worker and prevention efforts (which are in
too short supply and which may obscure the criminal nature of the conduct). In our public policy, the
line of demarcation is not so clear, and the problem starts with definitions.[4]
M.D. Martin, in a 1977 analysis, Child Abuse and Neglect Research, wrote, “The issue of
defining abuse and neglect is one of central importance and logically precedes a discussion of
incidence, etiology, and treatment. The vagueness and ambiguities that surround the definition of this
particular social problem touch every aspect of the field – reporting system, treatment program, research
and policy planning.”[5]

Twenty-five years after Martin’s statement, with the federal government now spending over 9
billion dollars annually on the problem, there is still not a clear consensus on what child maltreatment
is, why it occurs, nor what types of interventions are best to address it.[6]
“Certainly, whether a given incident under consideration represents physical abuse or just simply
an extreme form of parent-to-child discipline (e.g., beating vs. spanking/slapping) is not easy to
determine; thus there are blurred distinctions between abusive and sub-abusive or non-abusive behavior.
… Different definitions have been used to examine the nature and extent of child physical abuse. The
definition of child physical abuse in the Third National Incidence Study of Child Abuse and Neglect
defined physical abuse as present when a child younger than 18 years of age has experienced an injury
(harm standard) or risk of an injury (endangerment standard) as a result of having been hit with a hand
or other object, or having been kicked, shaken, thrown, burned, stabbed, or choked by a parent or
parent-surrogate.”[7]
Under federal law the term "child abuse and neglect" means, “at a minimum, any recent act or
failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional
harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious
harm.”[8] This definition is a part of CAPTA, the Child Abuse Prevention and Treatment Act.[9]
CAPTA further defines “child abuse crime” to mean, “a crime committed under any law of a State that
involves the physical or mental injury, sexual abuse or exploitation, negligent treatment, or
maltreatment of a child by any person.”[10]

These definitions, used for field research by academics, or used by the federal government to
govern grant-making or reporting decisions, are necessarily general. They are not “operational”
definitions in the sense that they are not used to prohibit specific conduct. For operational definitions it
is necessary to look to state law.
In the Legislature, differences of opinion and values are debated and either consensus is reached
or majorities rule. This political process leads to state laws that identify the specific elements of
unlawful conduct, and prescribe the consequences for engaging in it. Unlawful conduct may be a
criminal act (e.g., murder), it may be a civil wrong (e.g., accidentally killing another), or it may be both
(e.g., murder is also the tort of wrongful death.)
There is a clear national consensus that child abuse and neglect, at some level, is criminal
conduct. Every state has enacted statutes that criminalize child abuse and neglect. At the same time,
“child abuse and neglect” definitions also give rise to civil sanctions that can include termination of
parental rights. The triggers for these actions are dependent on definition by the Legislature.
The first challenge is to define “child abuse and neglect” with sufficient precision that people of
common understanding can know what conduct is prohibited. A statute cannot be “so vague that men of
common intelligence must necessarily guess at its meaning and differ as to its application.”[11] Once
we have defined criminal child abuse and neglect, by legislation, we must reach a common
understanding of what the consequences should be. Prison or jail, probation, “treatment,” fines,
restitution, and loss of parental rights are all options.
The next challenge is to reach consensus on whether all child abuse and neglect, as the legislature
defines it, should be criminal or whether there should be non-criminal child abuse and neglect as well.
If so, how should it be defined? And what consequences should be imposed in the non-criminal cases?
Permanent loss of parental rights, temporary loss, counseling and treatment to preserve or reunify the
family are all options we have tried, all too often when children also have been victims of criminal
abuse or neglect, because we did not focus closely enough on the differences.
These questions remain largely unresolved.
As a consequence, in our public discourse about child abuse and neglect, when we speak of
“abuse,” some hear “spanking” and reflexively defend the “rights of parents.” Others hear “beating” and
“torture” and reflexively condemn parents and push efforts to expand the state’s power over the family.
When “neglect” is discussed, some hear “poverty” or “poor parenting skills” and push social welfare
solutions; others hear “abandonment” and “crime,” and argue for a criminal sanction.
The intersection of these criminal and civil statutes is broad. Most of what justifies the
termination of parental rights or a dependency is also serious criminal conduct. Yet we do not generally
respond to child abuse or neglect in the same way we respond to criminal allegations. Evidence that a
parent has “neglected or wilfully abused a child” is sufficient to justify termination of parental rights.
[12] A child “may be taken into temporary custody… if [it] is clearly necessary to protect the child
because the child is either suffering or will imminently suffer abuse or neglect.” A.R.S. § 8-821 (B).
Presumably then, because the standard is “may” and therefore discretionary, a child need not be taken
into temporary custody under these circumstances, although in most cases the underlying conduct is a
crime. Should the parent then be taken into “temporary custody” by way of an arrest?
What divides the line between criminal and civil cases? What is a crime and what is a problem
that calls for a social worker? Would the invocation of the criminal law bring a seriousness to the matter
that might help in the long run? Or would it drive the problem underground? When are these two
systems, the civil and the criminal supposed to work together? And why is the criminal system used less
frequently?
Ultimately the operational definition of “child abuse and neglect” depends on each state’s
statutes. Under Arizona law, criminal child abuse occurs when a person having care or custody of a
child “causes the child to suffer physical injury,” or “permits a child to be … endangered,” among other
things.[13]
While we have grappled with these definitional issues for years, we have yet to summon the
understanding, discipline, or collective will to resolve them. This failure is of more than academic
interest. Children are the victims of our inability to resolve these debates with more clarity. There are
times when we seek to “reunify” children with criminal abusers because we have not thought critically
or clearly enough about the character of the abuse we confront. At times it seems as though we are
paralyzed by uncertainty; that we lack the conviction to keep children safe because we are not sure of
ourselves or the clarity of the moral principles that should govern our actions.
Nowhere is the moral confusion more clear than in the definition of “[p]rotective services” found
in A.R.S. § 8-801. One might think the definition of the phrase “protective services,” when used in
connection with the criminal abuse and neglect of children, might have something to do with protecting
children from abuse and neglect. One would be wrong. Here is the definition in full flower of its
bureaucratic splendor:
"Protective services" means an identifiable and specialized child
welfare program that seeks to prevent dependency, abuse and exploitation of
children by reaching out with social services to stabilize family life and that
seeks to preserve the family unit by focusing on families in which unresolved
problems have produced visible signs of dependency or abuse and the home
situation presents actual and potential hazards to the physical or emotional
well-being of children. The program shall seek to strengthen parental capacity
and ability to provide child care.
Protective services is a program which “seeks to prevent…abuse...by reaching out with social
services to stabilize family life,” and at the same time “seeks to preserve the family unit… .”
Fundamentally what this means is that perpetrators of criminal conduct are to receive “stabilizing”
services and “victims” are to be sent back to their victimizers.
The challenge for our public policy begins with the need to reach consensus on the moral values
we bring to the debate. For this, a return to first principles is necessary.
CHAPTER ONE: FIRST PRINCIPLES
At times it seems to be a system at war with itself, the easy target of critics and the faithless
companion of friends. But the war over child protective services policy is a war of our own making. In
our law we tell our beleaguered child protective services case workers that they must both protect the
safety of the children in their care, while at the same time undertaking “reasonable efforts” to reunify
criminally victimized children with their victimizers.
Indeed, the latest child welfare craze to sweep across the nation, “concurrent planning,” by its
very name bespeaks the kind of mild schizophrenia which characterizes our public policy regarding
criminally abused and neglected children. “Concurrent planning” is the label given to child protective
services efforts that simultaneously plan a child’s permanent future both with and without his or her
parents, where “both reunification and alternative permanency are pursued at the same time.”[14] It
would seem after more than a century of grappling with these difficult questions we would have found
some better answers.[15] As can be seen in the complex and contradictory approaches between the civil
law and the criminal law, answers continue to elude us. Perhaps as with all things that are terribly hard,
it has been easier to just look away.
When public policy seems to be veering off-course, or hopelessly complicated and enmeshed in
contradiction, a resort to basic principles is always necessary, and that is how we begin this report.
America’s first principles are expressed eloquently in the Declaration of Independence. None
holds a place more central in our hearts or in our history than this: “We hold these truths to be self-
evident, that all men are created equal, that they are endowed by their Creator with certain unalienable
Rights, that among these are Life, Liberty, and the pursuit of Happiness. That to secure these rights,
Governments are instituted among Men… .”[16]

This principle binds each American to a culture of freedom that places the rights of the individual
above the power of government. But it also binds us to a culture that protects individual rights against
private encroachment, not just public. And so we say that government’s primary duty is to protect the
natural rights of each person, from public or private infringement.
The “self-evident truth,” that each child comes into the world equally endowed at birth with
“unalienable Rights” to life, liberty, and the pursuit of happiness, remains the core value of the
American culture. It should be the foundation of all our public policy, including our policy regarding the
criminal abuse and neglect of children.
Sadly for our society, and tragically for it’s littlest ones, we have not been faithful stewards of this
first principle in our protection of the “self-evident” rights of children. Far too many are not free from
criminal abuse and neglect in their lives, liberties, and pursuit of happiness. Far too many are victims of
both abusers and the system that was designed to protect them. Every child born into this country ought
to be heir to a legacy of freedom; to every child should be given the unalienable rights which our
government promises to secure as the “blessings of liberty to ourselves and our posterity.”[17] Indeed,
we hold that it is the very purpose of government to secure these rights, and there is no exclusion for
children.
Yet, somehow, we have lost our way. Somehow, the promise to each child of an endowment of
unalienable rights has been forgotten, lost to the more powerful secular notion that children are the
property of their parents[18] and therefore not quite equal and not yet endowed.
To be sure, the State should not have the authority unreasonably to dictate to otherwise law-
abiding parents how they will raise their children. Parents need to nurture their children, and children
must learn respect and the virtue of self-governance. But this means simply that parents owe a special
duty to their children. However, today, in Arizona and across the nation, children remain trapped by
government laws and policies in homes where they suffer the pain of criminal abuse and neglect. And
we put them again and again in harm’s way because of a policy that, in practice, values family
preservation[19] before child safety. In doing so, we betray our first principles and the legacy of
freedom which was purchased for us at great price.
In our public discourse, we honor “family values,” and so we should. Surely the family is the
cornerstone of our civilization.
Within the family we should transmit our values as a nation. We should transmit the values of
love and protection, of responsibility and industry and citizenship. The family must be honored and not
undermined in our law.
But the family must never be a shield for criminality.
We honor the family in so far as it nurtures the growth of healthy and productive and free
citizens; it is a means to actualize our freedom, not an end in itself. If a family becomes destructive of
unalienable rights, it is the duty of a just society to restrain it, in order to protect more fundamental,
unalienable individual rights. Indeed, it is precisely because of the importance of the family, that any
assault within the family, which always threatens its strength and structure and cohesion, must be
considered not only serious in and of itself, but also a grave threat to the strength of the nation, and,
hence, a more serious crime.. Yet it is not so; not in our culture and not in our law.
Today, a criminal assault on a child, even a baby, committed within the family, can, depending on
how it is charged, be no more serious an offense than the same assault by a stranger on a stranger. They
both can be misdemeanors.[20] An assault on a corrections officer or police officer is a more serious
offense than the same assault committed against an infant or newborn baby.[21] It is a class 6 felony in
our state to subject an animal to cruel mistreatment;[22] it is not even a crime to addict a child in utero
to dangerous or narcotic drugs so that the child’s first days after birth are filled with tortuous pain.[23]
If a father assaults his daughter she may be forced to go to counseling with him, while she is
forced to remain in his home.[24] Surely it would be unthinkable for anyone to force the victim of a
mugging by a stranger to go to counseling with her mugger.
It would seem that a well-ordered society, which valued the family, would treat crimes within the
family as more serious offenses than crimes committed by strangers upon strangers. More is at stake
when the crime occurs within the family, more harm to the victim and more consequent harm to society
as a whole. Research now shows the profoundly harmful consequences that result from not intervening
sooner in the life of a criminally abused or neglected child.[25]

This study looks at our system of child protection and measures it against the philosophy of our
first principles. It looks at the history of child abuse laws in America and Arizona. It identifies
weaknesses in those laws and argues that we must make them stronger. It proposes that we
unequivocally place the right of a child to be safe from criminal abuse and neglect at the center of every
law, rule, policy, practice, procedure and process that we have regarding child and family welfare. It
reports on interviews with persons on the frontlines of the struggle to keep our children safe. It
summarizes many of their insights and reports their recommendations. It points out how the system is
not only under-funded, but perhaps more importantly, under-conceived. It suggests that it is time finally
to lift the veil of secrecy which shrouds our system of child protection.
How is it that we could be at a point in our history when it can be a more serious crime to mistreat
an animal[26] than to cause a baby an agonizing birth and death? The answers to this question are
woven through the story of law and policy, of history and practice that follows here. And it takes us,
ironically, to an intersection of animal and child welfare, in America, in the 1800’s.
CHAPTER TWO: NATIONAL HISTORICAL OVERVIEW
In the 1600’s, America was a harsh land for children. According to a special report by the
Sacramento Bee, children were “relevant only as assets to their parents,” and “poor, orphaned, or
illegitimate children frequently were indentured to learn trades.”[27] By the 1700’s, abandoned or
orphaned children were sent to live in “almshouses,” publicly funded shelters. Either relatives or
strangers could claim the children for household workers and receive public funds as “foster parents,”
but there was little or no check on the well-being of the children.[28] This system lasted well into the
19th century.
Then came Mary Ellen Wilson. In 1874, little 8 year-old Mary Ellen lived in the home of Francis
and Mary Connolly. She was the illegitimate daughter of Mary Connolly’s first husband. Etta Wheeler,
a “friendly visitor” who worked for a faith-based mission[29] learned from a neighbor that Mary Ellen
was being mistreated and went to the home for a visit. “She found Mary Ellen chained to a bed, covered
with bruises and scars and a cut on the left side of her forehead made when her ‘foster’ mother sliced
her with a pair of scissors.”[30] Etta Wheeler sought help from both police and social service agencies
in New York but was turned away. The police said no crime had been committed and the New York City
Department of Charities said they could not act because they did not have custody of Mary Ellen.[31]
Because there were inadequate laws and institutions to protect children from abuse Etta Wheeler turned,
with some tragic irony, to Henry Berge, the founder of the Society for the Prevention of Cruelty to
Animals. Berge persuaded his friend Elbridge Gerry to take up Mary Ellen’s cause.[32]
The court removed Mary Ellen from her foster home and placed her in an orphanage.[33]
Ultimately the foster mother was imprisoned for a year.[34] The case attracted significant coverage in
the media and it led, in December of 1874, to the founding of the Society for the Prevention of Cruelty
to Children.[35] Almost immediately other child protection agencies were created around the country.
[36]
In 1912 Pres. Theodore Roosevelt championed the creation of the U.S. Children’s Bureau, after
convening the first “White House Conference on Children.” The Bureau became responsible for
oversight of children’s institutions.[37] In 1935 the passage of the Social Security Act created a funding
framework which directed money to be used for the care of children who were neglected, abused or
abandoned. However, by 1959, the Child Welfare League of America reported that the delivery of these
social services was “uneven and discriminatory” and that children were removed from homes
unnecessarily and that foster homes were too often “unstable and undesirable.”[38] It noted that few
attempts to reunify families were ever made.[39] While the report was followed by a growth of in-home
services that child welfare agencies began to provide in the 1960’s, in truth the four decades from the
20’s through the 50’s saw the memory of Mary Ellen fading in the public consciousness. Little attention
in fact was paid to child abuse issues until the reawakening in the 1960’s.
In 1962, Dr. C. Henry Kempe and his colleagues published an article in the Journal of the
American Medical Association in which they identified the “battered child syndrome.” It was seminal
research that led, it is said, to a national rediscovery of child abuse. Kempe conducted a survey of
eighty-eight hospitals in which he confirmed over 300 children who had been “battered,”[40] many of
whom suffered brutal multiple injuries. According to Duncan Lindsey, Kempe’s report “ignited a broad-
based national effort to find ways to protect children.” This was 40 years ago. The report led to the
enactment of mandatory child abuse reporting systems that were supposed to ensure that whenever a
child was suspected of being battered, the case would be reported and some intervention would occur to
protect the child. Here is how Richard Gelles describes the developments that followed:
Between 1963 and 1967 every state and the District of Columbia passed some form of
child abuse reporting law. According to the public policy expert Barbara
Nelson, these reporting laws diffused through the states five times faster than
the average for public policy innovations between 1933 and 1966. There are
various explanations for this speed. Certainly a model reporting law
disseminated by the United States Children’s Bureau, an agency within the
then Department of Health, Education, and Welfare, facilitated the states’ rapid
adoption of reporting laws. Other model laws were drafted by the Council of
State Governments, the American Medical Association, and the American

Academy of Pediatrics. Rather than confusing the state governments, these
various model laws seemed to, in Nelson’s words, “superheat” the demands
for legislation.
Madatory-reporting laws had a number of attractive features. First, they “legalized” the
problem of child abuse. Second, mandatory –reporting laws were a sign that
state government was “doing something” about the problem. Third, and not a
trivial factor, was that of all the policy options available, reporting laws
appeared to be the least expensive that could address the problem. The last
assumption proved to be inaccurate. Physicians, legislators, and government
officials had dramatically underestimated the extent of the problem of child
abuse and the demand for services that would result from the reporting laws.
[41]
Arizona enacted its first mandatory reporting statute in 1964.[42] A nationwide count in 1967
confirmed 6,000 cases of reported child abuse. But a sample survey that accompanied the report
estimated based on survey results that there were millions of unreported cases.[43] The under-reporting
was attributed to only a small number of covered professionals actually knowing about the law, or
knowing how to make a report under it.[44]

Public awareness campaigns and improved telecommunications technology, including the advent
of WATS lines, brought an avalanche of reports. Gelles reports that in Florida, in 1970 alone, after a
statewide toll free number was installed and a public awareness campaign advertised it, the number of
reports went from 17 to 19,000.[45] In 1976 the National Center on Child Abuse and Neglect was
newly formed and began to collect the first national data on child abuse reporting. That year the Center
reported there were 669,000 reports of child abuse and neglect nationwide. By 1980 the number of
reports exceeded 1 million.[46]

Richard Gelles has observed, “The enactment of the reporting laws in the 1960’s essentially
decriminalized child maltreatment – with the exception of homicides. Thus child welfare agencies bear
almost the complete responsibility for investigating child abuse… [even though the conduct is
criminal].”[47] And so the law of unintended consequences reasserted itself and a fundamental conflict
in our public policy toward criminally abused and neglected children began to emerge.
When a stranger rapes or assaults a stranger, the police are called and no one questions that a
crime has occurred and that it should be investigated, the perpetrator apprehended and brought to
justice. By the middle of the 1970’s it was fairly well-established that the very same conduct when
committed within the home did not lead to a criminal justice response with the key aim being the
protection of the victim and society, but rather to a social welfare response directed at providing
“services” to “clients.” And children were left increasingly in harm’s way, even as the ranks of children
in foster care swelled. As Richard Gelles has summarized it, “In the 1960’s through the 1970’s, child
welfare policy had focused on removing children from dangerous homes. As the number of reports of
abuse swelled, so did the number of children removed from their parents. By the late 1970’s nearly …
500,000 children were in foster care.”[48]

The Child Abuse Prevention and Treatment Act (CAPTA) was passed by Congress and signed by
the President in 1974.[49] It provides federal funding to the States in support of prevention, assessment,
investigation, prosecution,[50] and treatment activities, among others. CAPTA also sets a minimum
definition of child abuse and neglect.[51] CAPTA has been amended several times since its original
enactment, but continues as the principal source of authorization for federal funding assistance for State
child abuse and neglect prevention efforts.[52]

In 1977, the U.S. Supreme Court reviewed several social problems that began to develop in the
child welfare system.[53] Children were found to remain in foster care for years, on average more than
four, with many remaining in the system indefinitely.[54] The Court noted that funds promoted
continued foster care rather than reunification.[55]

Against this developing backdrop, the Congress enacted and the President signed into law the
Adoption Assistance and Child Welfare Act of 1980.[56] This Act is generally considered the most
significant legislation in the history of child welfare.[57]
In response to the foster care problem that had emerged in the 1970’s, the Congress placed
stronger emphasis on family preservation and reunification and extended these requirements to state
child welfare systems. As Mary O’Flynn explains it, “Before enactment of P.L. 96-272, states could
only receive federal reimbursement for cases in which children were physically removed from the home
and placed in foster care. [Fn. omitted] P.L. 96-272 marked the first attempt by the federal government
to provide financial incentives to states to reduce the time each child spent in foster care and to
implement permanency planning for foster children. [Fn. omitted].”[58]

Among the more consequential of its provisions, P.L. 96-272 required that each State submit a
plan that had to contain certain provisions as a condition to the receipt of federal money. Among the
plan’s requirements was a provision that “in each case, reasonable efforts will be made (A) prior to the
placement of a child in foster care, to prevent or eliminate the need for removal of the child from his
home, and (B) to make it possible for the child to return to his home….”[59] Two contradictory
philosophies emerged from the act.
The first was permanency planning, which assumed that prompt and decisive action to
maintain children safely in their homes, or to place them as quickly as possible
in permanent homes with other families, was the most desirable goal of child
welfare services. The second goal was embodied in the words reasonable
efforts … .
States had to demonstrate that they made reasonable efforts and that they were in
compliance with the permanency planning provision of the law in order to
qualify for federal funding for adoption and foster care
Despite the law’s good intentions, it planted seeds of trouble. The goal of child protection
services became safeguarding children while also working to reunite them
with their abusive parents. The assumption was that these mandates could be
balanced successfully. The reality was that the demands were contradictory.
One problem was the ambiguity around the very concept of “reasonable efforts.” Nowhere
in the federal legislation, state policy, or ensuing legal decisions in state courts
were “reasonable efforts” ever clearly defined. As a result, child protection
workers, administrators, and legal staff had no guidelines for how much or
how long they had to make “efforts” at reunification before moving to
permanent placements for abused and neglected children. Similarly, the
inherent and dangerous contradiction between ensuring safety and attempting
to reunite abusive parents with abused children was never publicly
acknowledged by federal or state officials.[60]
Despite fundamental contradictions, support for family preservation and reunification programs
crossed political and philosophical lines. Conservatives supported the new emphasis on family sanctity
and the limitations on government intervention into the private sphere of the family; liberals endorsed
the programs as continuing in the tradition of government welfare to needy citizens.[61] The programs
promised saving money, strengthening families, and protecting children all at the same time.
A decade after the passage of the Adoption Assistance and Child Welfare Act states were
“running pell-mell into family preservation without fully considering the evidence for it,” according to
sociologist Peter Rossi.[62] The high point of the family preservation movement nationally may have
been the enactment in 1993 of the Family Preservation and Child Protection Reform Act. Signed by
Pres. Bill Clinton, the act has authorized hundreds of millions of dollars for family preservation
programs. Richard Gelles calls the programs a “failure.”
The promises were compelling… and soon unfulfilled.
Family preservation programs relied on the “reasonable efforts” requirement of the federal law
for their legal justification. The combination of these two factors, the growth of family preservation
funding and the legal standard which supported it, led once again to unintended consequences.
The intent of the reasonable efforts requirement was to help families remain together by
providing needed social services and to reunify families who were separated as
a result of foster care. Without a clear definition of the term, it has been
subject to varying interpretation, with unintended consequences for children
and families. The legislative history of ASFA highlights some of the problems
arising under the reasonable efforts term in P.L. 96-272. For example, in some
cases social workers and the courts have been accused of interpreting the term
too broadly and favoring parental rights over those of children by supplying
services for extended amounts of time. The reasonable efforts requirement has
been similarly criticized as placing children at risk by forcing children to
remain in the system for unreasonable lengths of time.
The reasonable efforts standard was created to enhance family preservation and
reunification services, rather than being used as a device to keep children in
the foster care system for extended periods or to return a child to a dangerous
or abusive home. The failure of P.L. 96-272 was vividly illustrated by a series
of highly publicized child deaths nationwide and by the rapid growth of a
foster care population which more children enter than exit each year.[63]
In 1997, Congress passed the Adoption and Safe Families Act.[64] It was intended to address
some of the problems that had arisen in the interpretation of the “reasonable efforts” requirement in the
intervening 17 years since its first adoption.[65] The Act extensively amended paragraph 15 of
42 U.S.C. §671a, by enumerating specific circumstances in which the Federal Government would not
require “reasonable efforts” to “preserve and reunify families.” These circumstances include when the
“parent has subjected the child to aggravated circumstances (as defined in State law, which definition
may include but need not be limited to abandonment, torture, chronic abuse, and sexual abuse.)”
Reunification services are not required when a child has been subjected to torture, but neither are they
prohibited.
Arizona has enacted statutes that address the issues and child abuse and the requirements of the
federal law that will be examined in Chapter Four.
CHAPTER THREE: THE SCOPE OF THE PROBLEM
National
In 2000, the latest year for which data is available, 3,000,000 calls came into child protection
agencies nationwide concerning the welfare of approximately 5,000,000 children; of these referrals 62%
were “screened-in” or accepted as reports.[66] Screened-in referrals alleging that a child was being
abused or neglected received investigations or assessments to determine whether the allegations of
maltreatment could be substantiated. Thirty-two percent of the investigations nationwide resulted in a
finding that the child was maltreated or at risk of maltreatment.
Approximately 879,000 children were found to be victims of child maltreatment. Maltreatment
categories include neglect, physical abuse, sexual abuse, and psychological maltreatment. Almost two-
thirds of child victims (63%) suffered neglect, 19% were physically abused, 10% were sexually abused,
and 8% were psychologically maltreated.

The rate of child victims per 1,000 children in the population was 12.2 in 2000, up slightly from
the year before, but lower than the rate in 1993 (15.3). Within the child age population, victimization
rates for children under three (15.7) were 3 times the rate for children 16 and 17 (5.7). Victimization
rates were similar for male and female victims (male 11.2; female 12.8) however, girls were much more
likely to be victims of sexual abuse (1.7 v. 0.04).
Approximately 1,200 children died of abuse or neglect in 2000, a rate of 1.71 children per
100,000 children in the population. Youngest children were the most vulnerable. Children younger than
one accounted for 44% of child fatalities and 85% of child fatalities were younger than 6 years of age.
Arizona
Arizona child abuse reports from DES are compiled semi-annually on a fiscal year basis, so Jan.-
Dec. calendar numbers are not routinely reported.[67] However, in the 12-month period from April 1,
2000 to March 31, 2001 the numbers for Arizona are reported.
During the 2000 - 2001 reporting period, there were a total of 32,441 reports of child abuse,
neglect and abandonment[68] received by the central intake unit of DES Child Protective Services. (In
the latest 12-month period the rate is running over 34,000 reports a year.) Of these reports, 3,070 were
substantiated,[69] representing a substantiating rate of 9.4% compared to the reported national rate of
32%. This comparison of substantiation rates raises a question which deserves further inquiry. Why
should Arizona’s rate be below the national average? Taking a closer look at the trends in Arizona
reveals an issue which needs additional research. The report and substantiation data for the last several
years is as follows:
Reports Substantiated Rate
July 1, 1996 – June 30, 1997 38,229 14,394 37.6
July 1, 1997 – June 30,1998 38,381 (NA) (NA)
July 1, 1998 – June 30, 1999 32,631 3,629 14
Oct. 1, 1999 – March 31, 2000 16,301 1.524 9.3

April 1, 2000 - Sept.30, 2000 16,047 1,789 11.1
Oct. 1, 2000 – March 31, 2001 16,394 1,281 7.8
April 1, 2001 – Sept. 30, 2001 17,064 1,496 8.7
Oct. 1, 2001 – March 31, 2002 17,504 1,484 8.4
The chart raises the question of why the substantiation rates in Arizona dropped and have
remained low. Are children in Arizona so much less likely to be victims of abuse and neglect? Are the
investigations inadequate to determine what actually happened? Are there too few workers to
investigate? Is the standard for substantiation somehow higher in Arizona than nationally? The answer
to the question is particularly important when national substantiation rates are considered.
U.S. Rate[70]
1996 28.5
1997 29
1998 26.2
1999 26.6
2000 28
In January of 1998 the state instituted the Family Builders Pilot Program which was designed to
provide services to families who were the subject of “lower priority” CPS reports.[71] The lower
substantiation rates may be related to the alternative way in which reports have been handled since the
initiation of this program. They may be related to the appeals process the state has established or to the
lack of clear guidelines as noted by the Auditor General’s Office in its November, 2002 Report. Equally
curious is the drop in the absolute numbers of reports. From 1991 to 2001 the number of children 0 – 14
in Arizona increased by almost 50%.[72] Can it be possible that the real numbers of reports of abuse or
neglect have in fact gone down from 38,229 in FY 98 to 34,568 in the last annual reporting period? Or
are different criteria being applied to qualify a call as a report? These questions deserve additional
inquiry.[73]
However the numbers of reports, investigations, and substantiations are measured, the raw
numbers reveal an enormous challenge.
A.R.S. §13-3620 requires a health care professional who believes that a newborn infant may be
affected by the presence of alcohol or a dangerous or narcotic drug to report the fact to CPS. But no law
requires CPS to maintain, compile, and publicly report these births. Moreover, no law currently requires
that law enforcement be called whenever a newborn is born affected. So we do not know the full scope
of this problem.
CHAPTER FOUR: CURRENT LAW
One main theme emerges from examining the case law, statutes, and rules which follow: there is
uncertainty, overlap, and ambiguity in the principles which govern how we apply the definitions of
criminal child abuse and neglect in practice. How that uncertainty manifests itself is a question which
requires a consideration first of the legal principles that are discussed in this chapter and next, by the
voices of the experts we report in the next chapter.
U. S. Supreme Court
Parents’ Rights Are Deemed Fundamental, But The State Has The Right And Duty To Protect
Minor Children
Federal and State statutes addressing child abuse and neglect, child removal, or family
preservation and reunification all exist in the shadow of the United States Constitution. The Supreme
Court of the United States has frequently emphasized the constitutional protection afforded the family.
The rights to conceive and to raise one’s children have been deemed “essential,” Meyer V. Nebraska,
262 U.S. 390 (1923), “basic civil rights of man,” Skinner v. Oklahoma, 316 U.S. 535 (1942), and “rights
far more precious than property rights,” May v. Anderson, 345 U.S. 528 (1953), “It is cardinal with us
that the custody, care, and nurture of the child reside first in the parents, whose primary function and
freedom include preparation for obligations the state can neither supply nor hinder,” Prince v.
Massachusetts, 321 U.S. 158 (1944).
The integrity of the family unit has found protection in the Due Process Clause of the Fourteenth
Amendment, Meyer v. Nebraska, the Equal Protection Clause of the Fourteenth Amendment, Skinner v.
Oklahoma, and the Ninth Amendment, Griswold v. Connecticut, 381 U.S. 479 (1965). In Stanley v.
Illinois, the Court found that the interest of a man “in the children he has sired and raised undeniably
warrants deference and, absent a powerful countervailing interest, protection.”[74] However, Justice
White, in his opinion, went on to foreshadow a circumstance when there may be just such a “powerful
countervailing interest” when he wrote, “The State’s right – indeed, duty – to protect minor children
through a judicial determination of their interests in a neglect proceeding is not challenged here.”[75]
The Burden of Proof Required to Terminate Parental Rights: Clear and Convincing
In Santosky v. Kramer[76] the Court held that before a state may sever completely and
irrevocably the rights of parents in their natural children, due process requires that the state support its
allegations by at least clear and convincing evidence. The Court noted the “historical recognition that
freedom of personal choice in matters of family life is a fundamental liberty interest protected by the
Fourteenth Amendment.”[77]
The fundamental liberty interest of natural parents in the care, custody and management of
their child does not evaporate simply because they have not been model
parents or have lost temporary custody of their child to the State. Even when
blood relationships are strained, parents retain a vital interest in preventing the
irretrievable destruction of their family life. If anything, persons faced with
forced dissolution of their parental rights have a more critical need for
procedural protections than do those resisting state intervention into ongoing

family affairs. When the State moves to destroy weakened familial bonds, it
must provide the parents with fundamentally fair procedures.[78]
Arizona Courts
The Rights Of Arizona Parents Are Fundamental, But Not Absolute, And May Be Terminated As
Provided By The Legislature
Arizona Courts have repeatedly held that a parent’s right to the custody and control of his or her
children is a fundamental right guaranteed by the United States Constitution. A typical and recent
description of this right is found in Michael M. v. Arizona Department of Economic Security:[79]

A parent's right to "the companionship, care, custody, and management of his
or her children" is a fundamental, constitutionally protected right, Stanley v.
Illinois, 405 U.S. 645, 651, 92 S.Ct. 1208, 1212, 31 L.Ed.2d 551, 558 (1972);
see also Santosky v. Kramer, 455 U.S. 745, 102 S.Ct. 1388, 71 L.Ed.2d 599
(1982), as is the right of association with one's children. In re Maricopa
County Juvenile Action No. JD-5312, 178 Ariz. 372, 873 P.2d 710 (App.1994).
These fundamental rights do " 'not evaporate simply because' the natural
parents 'have not been model parents or have lost temporary custody of their
child to the state.' " In re Maricopa County Juvenile Action No. JS-500274,
167 Ariz. 1, 4, 804 P.2d 730, 733 (1990), quoting Santosky, 455 U.S. at 753,
102 S.Ct. at 1395, 71 L.Ed.2d at 606.
The Arizona Supreme Court has expressed the general law and context in which child abuse and
neglect issues and parental rights must be considered:
Severance of parental rights necessarily involves the consideration of
fundamental, often competing, interests of parent and child. "This court and
the United States Supreme Court have long recognized that the right to the
control and custody of one's children is a fundamental one." In re Maricopa
County Juvenile Action No. JS-500274, 167 Ariz. 1, 4, 804 P.2d 730, 733
(1990) (Action No. JS-500274 ). "[T]his fundamental right 'does not evaporate
simply because' the natural parents 'have not been model parents or have lost
temporary custody of their child to the state.' " Id. (quoting Santosky v.
Kramer, 455 U.S. 745, 753, 102 S.Ct. 1388, 1394-95, 71 L.Ed.2d 599 (1982)).
The right of a parent to custody of his child, however, is not absolute. The
State can terminate parental rights under specified circumstances and
procedures. In Arizona, "[t]ermination of parental rights is **685 *249

governed solely by A.R.S. § 8-533." In re Pima County Juvenile Severance
Action No. S-114487, 179 Ariz. 86, 95, 876 P.2d 1121, 1130 (1994) (Action
No. S-114487 ). To justify termination of the parent-child relationship, the trial
court must find, by clear and convincing evidence, at least one of the statutory
grounds set out in section 8-533, and also that termination is in the best
interest of the child. See A.R.S. § 8-533.B.[80]
Duty to Reunify
Division One of the Arizona Court of Appeals has ruled reunification efforts must be undertaken
in the case of a parent whose mental disability prohibits proper parenting.[81]

In Mary Ellen C., the question was whether the state was required to make reasonable efforts to
reunify the family before seeking severance on the statutory basis that the parent suffers "a mental
illness of prolonged and indefinite duration."[82] The court noted that the requirement that ADES make
an effort to reunify the family was based on "the fundamental liberty interest of the natural parents in
the care, custody and management of their child." (quoting Santosky v. Kramer, 455 U.S. 745, 753, 102
S.Ct. 1388, 71 L.Ed.2d 599 (1982)). The court concluded that “fundamental interests are no less
involved in mental illness-based severances than in others” and that “termination of the parent-child
relationship should not be considered a panacea but should be resorted to only when concerted effort to
preserve the relationship fails.” But the court also noted that the State need not “undertake
rehabilitative measures that are futile,” but only that it had “to undertake measures with a reasonable
prospect of success.” The court concluded, in order to terminate parental rights, ADES is required to
prove, by clear and convincing evidence, that "it had made a reasonable effort to provide [the mother]
with rehabilitative services or that such an effort would be futile."
In a later case the same court identified limits on the duty to reunify. In Toni W. v. Arizona Dept.
of Economic Sec.[83]the court reviewed a case involving a mother who allegedly abandoned her child
at birth.
In this opinion we address whether the Arizona Department of Economic
Services (ADES) had a duty to offer reunification services to the mother
before petitioning for severance...
The mother argues that ADES had a duty to make a "concerted effort" to unify
the family before terminating her parental rights pursuant to federal law and
A.R.S. § 8-533(B)…
The federal law to which mother refers requires that, to be eligible for federal
grants for child welfare services, ADES must have a plan for foster care and
adoption assistance that, among other things, provides that reasonable efforts
will be made to both prevent or eliminate the need to remove a child from the
home, and to make it possible for the child to safely return to the home. 42
U.S.C. § 671(a)(15)(B). These reunification efforts, however, are not required
in all situations.
For example,
[R]easonable efforts of the type described in subparagraph (B) shall not be
required to be made with respect to a parent of a child if a court of competent
jurisdiction has determined that--
(1) the parent has subjected the child to aggravated circumstances (as defined
by State law, which definition may include but need not be limited to
abandonment....) 42 U.S.C. § 671(a)(15)(D).
Thus, the federal law has recognized the futility of requiring that "reunification
services" be provided in an abandonment situation.
The United States Supreme Court has long recognized that the fundamental
right of parents to the care, custody, and control of their children is protected
by the due process clause of the United States Constitution. Santosky v.
Kramer, 455 U.S. at 753, 102 S.Ct. 1388. However, the Court has also
recognized that "the mere existence of a biological link does not merit
equivalent constitutional protection." Lehr v. Robertson, 463 U.S. 248, 258,
103 S.Ct. 2985, 77 L.Ed.2d 614 (1983).
In the absence of such a [nurturing] parental relationship, a biological parent's

interest in the child is nothing more than a genetic link, unaffected by a
termination of parental rights.
This passage makes several things clear. First, some reunification efforts may be mandated on
constitutional grounds, based on "the fundamental liberty interest of the natural parents in the care,
custody and management of their child." Santosky v. Kramer, 455 U.S. 745, 753 (1982).
Second, the right to reunification efforts, however, is not absolute. The Supreme Court has
recognized that "the mere existence of a biological link does not merit equivalent constitutional
protection." Lehr v. Robertson, 463 U.S. 248, 258, (1983). As Justice White noted, “The State’s right –
indeed, duty – to protect minor children through a judicial determination of their interests in a neglect
proceeding is not challenged….”[84]

Reunification efforts are not required, applying a fair reading of both federal and state law, to
establish the statutory ground of abandonment. The law is clearer in the case of physical abuse.
Statutes and Rules
Just as Federal and State statutes exist in the shadow of the U.S. Constitution, so too the case
decisions of the courts arise in the context of, and are decided in the shadow of, statutes passed by
legislative bodies.
Federal Statutes
The principal federal statute remains CAPTA. CAPTA requires that a state, in order to be eligible
to receive federal money for child abuse and neglect prevention programs, must have a “plan” that
coordinates with the planning requirements for adoption assistance money [as set forth in the Adoption
and Safe Families Act, see below] and, among other things, must contain:
(i) provisions or procedures for the reporting of known and suspected instances of child
abuse and neglect;
(ii) procedures for the immediate screening, safety assessment, and prompt investigation
of such reports;
(iii) procedures for immediate steps to be taken to ensure and protect the safety of the
abused or neglected child and of any other child under the same care who may also be in
danger of abuse or neglect and ensuring their placement in a safe environment;
(iv) provisions for immunity from prosecution under State and local laws and regulations
for individuals making good faith reports of suspected or known instances of child abuse or
neglect;
(v) methods to preserve the confidentiality of all records in order to protect the rights of
the child and of the child's parents or guardians,
…
(vii) the cooperation of State law enforcement officials, court of competent jurisdiction,
and appropriate State agencies providing human services in the investigation, assessment,
prosecution, and treatment of child abuse or neglect;
…
(xii) provisions, procedures, and mechanisms … that assure that the State does not require
reunification of a surviving child with a parent who has been found by a court of competent
jurisdiction--
(I) to have committed murder (which would have been an offense under section 1111(a)
of Title 18 if the offense had occurred in the special maritime or territorial jurisdiction of
the United States) of another child of such parent;
(II) to have committed voluntary manslaughter … of another child of such parent;
(III) to have aided or abetted, attempted, conspired, or solicited to commit such murder or
voluntary manslaughter; or
(IV) to have committed a felony assault that results in the serious bodily injury to the
surviving child or another child of such parent; and
(xiii) an assurance that, upon the implementation by the State of the provisions,
procedures, and mechanisms under clause (xii), conviction of any one of the felonies listed
in clause (xii) constitute grounds under State law for the termination of parental rights of
the convicted parent as to the surviving children (although case-by-case determinations of
whether or not to seek termination of parental rights shall be within the sole discretion of
the State);
As originally enacted, CAPTA required “reasonable efforts” to reunify an abused child with his
abuser. The “reasonable efforts” requirement has narrowed in the CAPTA requirements for the state
plan and has been clarified and narrowed by the Congress through the Adoption and Safe Families Act
of 1997.
After the Adoption and Safe Families Act amendments, 42 U.S.C. § 671a now provides that in
order to qualify for grants to States for foster care and adoption assistance money, the State plan must:
(15) provide[s] that--
(A) in determining reasonable efforts to be made with respect to a child, as

described in this paragraph, and in making such reasonable efforts, the child's
health and safety shall be the paramount concern;
(B) except as provided in subparagraph (D), reasonable efforts shall be made

to preserve and reunify families--
(i) prior to the placement of a child in foster care, to prevent or eliminate the
need for removing the child from the child's home; and
(ii) to make it possible for a child to safely return to the child's home;
(C) if continuation of reasonable efforts of the type described in subparagraph

(B) is determined to be inconsistent with the permanency plan for the child,
reasonable efforts shall be made to place the child in a timely manner in
accordance with the permanency plan, and to complete whatever steps are
necessary to finalize the permanent placement of the child;
(D) reasonable efforts of the type described in subparagraph (B) shall not be
required to be made with respect to a parent of a child if a court of competent
jurisdiction has determined that--
(i) the parent has subjected the child to aggravated circumstances (as defined
in State law, which definition may include but need not be limited to
abandonment, torture, chronic abuse, and sexual abuse);
(ii) the parent has--
(I) committed murder (which would have been an offense under section
1111(a) of Title 18, if the offense had occurred in the special maritime or
territorial jurisdiction of the United States) of another child of the parent;
(II) committed voluntary manslaughter (which would have been an offense

under section 1112(a) of Title 18, if the offense had occurred in the special
maritime or territorial jurisdiction of the United States) of another child of the
parent;
(III) aided or abetted, attempted, conspired, or solicited to commit such a

murder or such a voluntary manslaughter; or
(IV) committed a felony assault that results in serious bodily injury to the
child or another child of the parent; or
(iii) the parental rights of the parent to a sibling have been terminated
involuntarily;
(E) if reasonable efforts of the type described in subparagraph (B) are not
made with respect to a child as a result of a determination made by a court of
competent jurisdiction in accordance with subparagraph (D)--
(i) a permanency hearing (as described in section 675(5)(C)) shall be held for
the child within 30 days after the determination; and
(ii) reasonable efforts shall be made to place the child in a timely manner in
accordance with the permanency plan, and to complete whatever steps are
necessary to finalize the permanent placement of the child; and
(F) reasonable efforts to place a child for adoption or with a legal guardian
may be made concurrently with reasonable efforts of the type described in
subparagraph (B).
These two federal laws, CAPTA and Adoption and Safe Families Act, drive much of what must
be contained in Arizona statutes governing termination and dependency actions, and the CPS response
to allegations of child abuse and neglect in general.
Confidentiality
CAPTA requires that States adopt “methods to preserve the confidentiality of all records in order
to protect the rights of the child and of the child's parents or guardians.” (Emphasis added). It goes on
to make several exceptions.
Arizona had responded to this requirement with A.R.S. § 8-807. The statute provides that
“department records on specific cases of child abuse and neglect are confidential.” There then follows a
long list of exceptions.
Criminal Child Abuse and Neglect in Arizona Statutes
The principal statute defining criminal child abuse is A.R.S. §13-3623. The elements of the
offense focus on the standard of harm or likely harm to the victim. It is set forth here in relevant part:
13-3623. Child or vulnerable adult abuse; emotional abuse; classification; exception;

definitions
A. Under circumstances likely to produce death or serious physical injury, any person
who causes a child or vulnerable adult to suffer physical injury or, having the care or
custody of a child or vulnerable adult, who causes or permits the person or health of the
child or vulnerable adult to be injured or who causes or permits a child or vulnerable adult
to be placed in a situation where the person or health of the child or vulnerable adult is
endangered is guilty of an offense … .
B. Under circumstances other than those likely to produce death or serious physical
injury to a child or vulnerable adult, any person who causes a child or vulnerable adult to
suffer physical injury or abuse or, having the care or custody of a child or vulnerable
adult, who causes or permits the person or health of the child or vulnerable adult to be
injured or who causes or permits a child or vulnerable adult to be placed in a situation
where the person or health of the child or vulnerable adult is endangered is guilty of an
offense … .
C. For the purposes of subsections A and B of this section, the terms endangered and
abuse include but are not limited to circumstances in which a child or vulnerable adult is
permitted to enter or remain in any structure or vehicle in which volatile, toxic or
flammable chemicals are found or equipment is possessed by any person for the purpose
of manufacturing a dangerous drug in violation of section 13-3407, subsection A,
paragraph 4.
F. For the purposes of this section:
1. "Abuse", when used in reference to a child, means abuse as defined in section 8-201,
except for those acts in the definition that are declared unlawful by another statute of
this title …
2. "Child" means an individual who is under eighteen years of age.
4. "Physical injury" means the impairment of physical condition and includes any skin
bruising, pressure sores, bleeding, failure to thrive, malnutrition, dehydration, burns,
fracture of any bone, subdural hematoma, soft tissue swelling, injury to any internal
organ or any physical condition that imperils health or welfare.
5. "Serious physical injury" means physical injury that creates a reasonable risk of
death or that causes serious or permanent disfigurement, serious impairment of health
or loss or protracted impairment of the function of any bodily organ or limb.
It is a crime in Arizona to “cause a child to suffer physical injury or abuse” or to “cause or permit
a child… to be placed in a situation where the person or health of the child is endangered.”
“Physical injury” is defined within the statute. The definition expands the definition of the same
phrase found in A.R.S. §13-105, by which “physical injury” means simply the “impairment of physical
condition.” The definition of “abuse” is referenced to A.R.S. §8-201:
"Abuse" means the infliction or allowing of physical injury, impairment of bodily

function or disfigurement or the infliction of or allowing another person to cause serious
emotional damage as evidenced by severe anxiety, depression, withdrawal or untoward
aggressive behavior and which emotional damage is diagnosed by a medical doctor or
psychologist pursuant to section 8-821 and is caused by the acts or omissions of an
individual having care, custody and control of a child. Abuse shall include inflicting or
allowing sexual abuse pursuant to section 13-1404, sexual conduct with a minor pursuant
to section 13-1405, sexual assault pursuant to section 13-1406, molestation of a child
pursuant to section 13-1410, commercial sexual exploitation of a minor pursuant to section
13-3552, sexual exploitation of a minor pursuant to section 13-3553, incest pursuant to
section 13-3608 or child prostitution pursuant to section 13-3212.
The elements of the offense focus on the definition of physical injury. Note again, “physical
injury" means the impairment of physical condition and includes any skin bruising, pressure sores,
bleeding, failure to thrive, malnutrition, dehydration, burns, fracture of any bone, subdural
hematoma, soft tissue swelling, injury to any internal organ or any physical condition that imperils
health or welfare.
Parsing through the definitions, it is readily apparent that “causing a child to suffer any skin
bruising,” for example, or “any impairment of physical condition or bodily function” or “serious
emotional damage” is a felony. If it is done intentionally, and the circumstances are such that the
conduct is likely to produce death or serious physical injury, it may be a class 2 felony, punishable as a
dangerous crime against children (meaning the sentences are long and mandatory). “Serious physical
injury” means physical injury that creates a reasonable risk of death or that causes serious or permanent
disfigurement, serious impairment of health or loss or protracted impairment of the function of any
bodily organ or limb.
If the circumstances are other than those likely to produce death or serious physical injury, then
the abuse may be up to a class 4 felony, if it is intentional, and a class 6 felony (and therefore potentially
a misdemeanor) if done with criminal negligence. An act is done with “criminal negligence” if the actor
is unaware of a substantial and unjustifiable risk that the result (the child’s injury) will occur and that
unawareness is a gross deviation from the standard of care that an ordinary person would observe.[85]
Neglect
“Neglect” is less clearly defined in the criminal law of Arizona. By inference, some “neglect”
conduct is covered by the abuse statute. “Permitting” the “person or health of a child” to be “injured” or
“endangered”[86] is surely a form of neglect. So is “permitting” a “minor’s” “health to be injured by

neglect.” A.R.S. §13-3619 makes the foregoing a misdemeanor. It does not include a definition of the
word “neglect.”
Dependency
A.R.S. §13-3612 makes “contributing to delinquency and dependency” of a child a class 1
misdemeanor. A “dependent child” is one, among several standards included in the statute, who is
“found wandering and not having a home” or whose home is “unfit” by “reason of neglect, cruelty, or
depravity.”
Assault
A person may commit an assault on a child by “intentionally, knowingly, or recklessly causing
any physical injury,” or placing the child “in reasonable apprehension of imminent physical injury,” or
“knowingly touching [the child] with the intent to injure, insult, or provoke.”[87] If the child is under
the age of 16 the assault is an aggravated assault, punishable as a class 6 felony, which may be treated
as a misdemeanor.[88]
Defining Child Abuse and Neglect for Termination and Dependency Under our statutes, in
addition to criminal sanctions, abuse and neglect may also lead to the state intervening into the parent-
child relationship by terminating it or temporarily interrupting it.
Title 8 of the Arizona Revised Statutes contains the laws which govern dependency, termination,
and reunification issues. Key provisions are compiled and set forth in Appendix A.
A.R.S. § 8-533 (B) sets forth the “evidence sufficient to justify the termination of the parent-child
relationship.” [89] Note that the word “justify” does not require the court to sever in any cases, but
rather merely authorizes. Among its other provisions, the statute includes as grounds for termination
that the parent has “abandoned the child” or has “neglected or wilfully abused the child.”
The statute also justifies termination when the child has already been removed and the state made
“a diligent effort to provide appropriate reunification services” but , within a period of nine months or
more after the removal of the child the parent has “neglected or wilfully refused” to correct the
circumstances that led to the removal,[90] or the child has been in an out-of-home placement for “a
cumulative total period of fifteen months or longer” and the parent is unable to correct the
circumstances that led to the removal and there is “a substantial likelihood” that the parent won’t
change.[91]
Additionally, the statute “justifies” termination if the child was removed from the parent, then
returned after “diligent reunification efforts,”[92] then removed again, and the parent is unable to
change.
However, in each of the foregoing cases, the law requires again that the court “shall consider the
availability of reunification services.”[93]

Grounds For Removal And Due Process Protections
A.R.S. § 8-821, et seq., governs the taking of a child into temporary custody. Under the statute, a
“child shall be taken into temporary custody in proceedings to declare a child a temporary ward of the
court to protect the child, pursuant to an order of the juvenile court on a petition by an interested person,
a peace officer or a child protective services worker under oath that reasonable grounds exist to believe
that temporary custody is clearly necessary to protect the child from suffering abuse or neglect.” The
statute continues that a “child may be taken into temporary custody by a peace officer or a child
protective services worker if temporary custody is clearly necessary to protect the child because the
child is either: 1. Suffering or will imminently suffer abuse or neglect; or 2. Suffering serious physical
or emotional damage that can only be diagnosed by a medical doctor or psychologist.”
Following taking a child into temporary custody, the statutes mandate notice and subsequent
hearings to be held very quickly. In most cases written notice to the parents must be provided within 6
hours, in some cases sooner.[94] Within five to seven days of the taking of the child into temporary
custody, the court must hold a “preliminary protective hearing.” If the court finds “probable cause to
believe that continued temporary custody is clearly necessary to prevent abuse or neglect pending the
hearing on the dependency petition” the court may continue the temporary custody. Before this hearing
there is an obligation for the parties to meet and attempt to reach agreement about the placement of the
child.[95] Throughout these statutes there is an emphasis both on using family-reunification services,
unqualified by the extent of the abuse or neglect, and on the health and safety of the child; these two
standards existing side-by-side in an uneasy coexistence.
If a child is determined to be dependent because of, among other things, abuse, neglect, or
abandonment, the court may, nonetheless, award the dependent child “[t]o the care of the child’s
parent’s, subject to the supervision of the department of economic security.”
A.R.S. § 8-861 provides that a child who has been removed from a parent, after the temporary
custody hearing, on request of the parent, “shall… be returned to the child’s parent or guardian if the
court finds by a preponderance of the evidence that the return of the child would not create a substantial
risk of harm to the child’s physical, mental or emotional health or safety.”
The study has identified compilations of laws from other states that address child abuse and
neglect. These statutes are attached as Appendix B. A summary of case law is attached at Appendix C.
Arizona DES Administrative Rules
The rules which have been promulgated by DES to further implement the foregoing statutes are
contained in R6-5-5501 et seq. According to these rules a report of “child maltreatment”[96] may not be
“substantiated” unless “a CPS Specialist has concluded, after an investigation, that there is probable
cause to believe an alleged abuser committed an act of child maltreatment.” (Emphasis added). There is
no statutory requirement that “maltreatment” may be substantiated only after identifying the abuser; it is
merely a product of DES rule.
The rules further provide reports of child abuse or neglect may be referred for “alternative
investigation” or to the family builders program.[97]

When a decision to investigate an allegation is made, the rules permit the CPS Specialist to
exclude or include the alleged abuser from participating in an interview with the victim. R6-5-5508 (C).
When conducting the investigation, the rules allow, but do not require, CPS to consult with law
enforcement. R6-5-5508 (B) (6). A.R.S. § 8-304 places primary responsibility for “the complete
investigation of all complaints of alleged dependency” on “child protective services specialists” within
DES.
CPS may “substantiate” a case of child abuse or neglect but determine there is no “risk of
imminent harm to a child” and close the case. There is no definition of imminent harm, but the rules
enumerate several circumstances where it might be found. The enumeration found in R6-5-5512
includes “severe or serious non-accidental injuries that require immediate medical attention.” Injuries
not meeting this standard do not, in and of themselves, give rise to a finding of imminent risk. This
means that recent, but healing, injuries do not qualify, even though they may have been “severe.”
In situations where “severe or serious non-accidental injuries that require medical care” are
found, CPS is authorized, pursuant to its own rule, R6-5-5513, to allow the abuser to leave the home.
R6-5-5511 (C) requires that “CPS shall offer a family voluntary protective services before filing a
dependency action.” After removing a child, CPS has 48 hours to file a dependency petition, or return
the child, R6-5-5514. A.R.S. § 8-821 now allows 72 hours.[98]

There are substantial parallels in the definitions of abuse and neglect to the criminal statutes, so
that the very same conduct that subjects a person to criminal prosecution also is grounds for termination
or dependency. As noted above, A.R.S. §8-201 (2) defines “abuse” to include “the infliction or allowing
of physical injury.” Clearly conduct of this nature is also criminal. The decision to proceed one way or
the other is not always made consciously with every stakeholder at the table.
In A.R.S. §8-201 (21), "[n]eglect" means the inability or unwillingness of a parent, guardian or
custodian of a child to provide that child with supervision, food, clothing, shelter or medical care if that
inability or unwillingness causes substantial risk of harm to the child's health or welfare, except if the
inability of a parent or guardian to provide services to meet the needs of a child with a disability or
chronic illness is solely the result of the unavailability of reasonable services.
These cases, statutes, and rules form the structure of the legal system our government, federal and
state has constructed to address child abuse and neglect. Within this legal structure, real people must
address the real problems of criminally abused and neglected children. How the system actually works,
fails, and is perceived, is best heard in the voices of those professionals on the front lines. We turn now
to their voices, the voices from the field.
CHAPTER FIVE: VOICES FROM THE FIELD: COMMENTS AND FIELD

RECOMMENDATIONS
The foregoing chapters have provided an overview of Arizona’s case law, statutes, and rules; it is by
no means exhaustive. To understand what professionals “in the trenches” are seeing, and to hear what
they recommend the study went in to the field and conducted 163 interviews with key professionals.
No effort was made to select or screen the individuals for any particular views or philosophies.
No preconditions were set on what those interviewed could say. Every interview followed a list of set
questions for consistency but no censorship was imposed on the views expressed. In the following
chapter the views and recommendations that emerge are remarkably consistent given the diversity of
professionals who were interviewed.
Throughout our report on “voices from the field” we have attempted to remain faithful to the
concerns and recommendations as they were given to us. The “voices” are reported in the words that
were given to us.
So let us turn to the professional voices from the field.
From September, 2002 to January, 2003 interviews were conducted with 163 professionals in the
fields of law enforcement, prosecution, the judiciary, CPS workers, medicine and nursing, social work,
foster parents, community service providers, and other allied professionals. The questions asked of each
group are attached at Appendix D.
The results of the interviews, the opinions given and recommendations made are summarized
below. A complete table of responses follows the summary narrative.
Purpose of the system, individual roles and interests
Regardless of their role in the child welfare system, from those interviewed, there is a consensus
that the first priority of the system ought to be working for the safety and well being of children.
Perhaps to state that is to state the obvious. Yet the surveys also reveal that this is too often not the first
priority in practice, despite the best intentions of those who work to make it so. There is also a strong
sense of advocating and helping children who have been victimized, along with protecting and
preventing future or recurring abuse. Most, if not all of those interviewed indicated a strong
commitment to children and desire to help families succeed (see Tables 1-4).
While most of the comments focused around child safety, protection and well-being, it was
evident from the comments of CPS workers that they struggle with another perception of their mission –
keeping families together.
Interface with CPS
Interaction typically takes place when CPS notifies the police, community service agency, or
medical professional and vice versa. That notification can vary in both quantity and quality depending
on the circumstances and individuals involved. It is evident that all of these professionals play a
significant role and must work together to successfully provide for the safety of children (see Table 5).
Opinion of CPS
Of those who interact with CPS on a regular basis, most had issues with CPS (see Table 6).
Most police officers noted their problems with investigations when CPS is involved and the
different timelines they operate under. Additionally, many others noted relationship problems and the
recognition that CPS workers are overworked and lack the resources, training, and knowledge to do the
job adequately.
More importantly, most felt their primary goal and that of CPS frequently conflicted. While those
outside of CPS saw their primary purpose as child safety and protection, many felt CPS’ focus was
family reunification. When questions were posed to CPS workers regarding case planning and
evaluation, many responded that they evaluated based on the primary goal of reunification (see Table 7).
This goal conflict was also evident when CPS workers were asked questions regarding their
understanding of “reasonable efforts” (see Table 8).
Examples of dissatisfaction
Police officers, physicians and medical social workers were asked to give examples of their
dissatisfaction with CPS or cases they were aware of that resulted in a bad outcome. Multiple specific
cases are noted in following areas: 1) multiple prior reports to CPS; 2) victims who recant their story or
fail to cooperate; 3) lack of evidence; 4) children that should not have been reunited with family; 5)
policy problems; and 6) examples where CPS failed to act (see Table 9).
COMMON ISSUES IDENTIFIED BY SURVEY PARTICIPANTS
Child Abuse Risk Factors
The top consensus responses among the different professions interviewed (see Tables 10 and 11):
§ Substance abuse
§ Financial instability and poverty
§ Lack of education and job skills
§ Families isolated with no family or community support
§ Stress or domestic violence in the home and/or a history of abusive relationships
§ Lack of parenting skills and teen parents
§ Mental illness
§ Continued domestic violence and/or mental health problems
§ Lack of support to correct problems in the home
§ The failure of the system
All of those interviewed stated that substance abuse is evident in the majority of cases they see.
Parents who abuse drugs or alcohol are more concerned with the drug versus the welfare of their
children. Male adults who use drugs often let their inhibitions down allowing sexual or physical abuse
to occur. Women often physically abuse or neglect their children, because the kids are getting in the
way of their drug use (see Table 12).
Caseload
Judges continue to see child abuse and neglect as pervasive social problems (see Table 13). They
feel that these types of cases are more time consuming and require additional investigation and
evaluation.
Police officers and detectives interviewed saw a wide range in caseloads. The typical response
was in the 20 to 50 per month range, with some officers indicating a caseload as high as 70 to 100 open
cases per month. All seem to agree that their caseloads are overwhelming. Some indicated that the
ideal caseload needed to be less than 30 per month.
The average caseload of those CPS workers interviewed ranged widely as well -- most in the
range of 12-20 on-going cases (children) per worker. High caseloads and the demands of the job were
also noted as reasons for high caseworker turnover. When asked on average how many times a case
worker can change on a case, some indicated 2-3 times while others noted the fact it could be higher.
Child abuse protocol

While most police officers and CPS workers understand that a protocol exists, many indicated
they have difficultly following it for several reasons (see Table 14). Typically it had to deal with a lack
of time and resources to follow it accurately or a general lack of knowledge or experience in how to
handle cases. The tension between various police departments and CPS was also evident with many
officers feeling that a breakdown in protocol by CPS can lead to problems in investigations. When the
question was posed to police officers whether there should be a referral to law enforcement for every
CPS case, the overwhelming response was no (see Table 15). Mainly due to the amount of manpower
and resources it would take to do the investigations adequately. Respondents believed the police should
do all criminal investigations and that CPS, should deal with non-criminal problems and help families.
If there is overlap with matters that are also criminal CPS should be required to follow the protocol.
Timeframes
The conflicts between police departments and CPS in the time required to complete an
investigation was also a major concern. While a CPS worker has their timeframe spelled out by
priority, many police officers noted no real standard (see Table 16). Most would agree however, that
these timeframes and expectations are unrealistic and many feel pressed for time to adequately do the
job. When police officers were asked what time would be needed to finish the case, most recognized
the fact that it needs to be completed as soon as possible to prevent further abuse and to increase the
chances for a successful prosecution (see Table 17). Most police officers admit that the majority of the
time they fail to meet a deadline they feel is necessary to successfully complete an investigation. CPS
workers believe they complete timelines; however police officers and others expressed grave concern
that they often close cases too prematurely and are reluctant to evaluate and monitor cases at an
appropriate level.
Resources
Frustrations by the lack of manpower and resources were evident by those on the front lines –
police officers and CPS workers (see Table 18). Others were also sympathetic to the fact that the
system is overloaded without the proper resources to ensure the safety of all children. It is generally
understood that more resources would allow the system to concentrate on quality versus quantity.
The issue of resources also came up when it came to placement options for abused and neglected
children. Part of the reason many feel that children stay in a “risky” situation is the inability to place
them elsewhere. Questions were even raised as to the quality of the placement options that were
available, i.e. shelters and foster homes.
Training
The feeling of inadequate training and knowledge about all aspects of the system was evident in
all the interviews that were conducted. While many, including CPS workers themselves, blamed the
lack of skilled CPS caseworkers, others pointed the finger at all members of the system who need to
have a greater understanding of child abuse and other family issues. Police officers themselves also
indicated a strong desire for more training.
Family Services
All of those interviewed understood the need and value of excellent treatment and other resources
to help families succeed. However, many raised the fact that the quality and availability of services was
inadequate. Others questioned their effectiveness. Part of the problem stems from the voluntary nature
of these services and that lack of accountability of families who agree to receive services.
Lack of Cooperation/Communication
Many raised problems when it came to working with each other. One CPS worker seemed to
express it best when she indicated that is seems like the goal of the system “is not to work with other
agencies.” Territoriality and a lack of accountability contribute to agencies operating in isolation from
one another. There was evident a lack of communication and cooperation voiced by different members
of the system throughout the interviews. In particular the need to share and receive vital information
that will assist in the proper handling of cases from one member of the system to the next was needed.
CPS confidentiality policies were viewed by many as a significant reason for this.
Legal and Policy Issues

A whole range of legal and policy issues were raised throughout the questioning of all
individuals. Many of these issues that surfaced are addressed under the recommendations. Issues
related to the vagueness of neglect laws; conditions in which an abuse or neglected child should be
reunited with a family; what should be done with babies born substance-exposed; and the need for
mandatory services to ensure that families receive the help that they need, are but a sampling of issues
raised (see Tables 18, 19 and 20).
RECOMMENDATIONS OF SURVEY PARTICIPANTS BY PROFESSION
Judges
The top recommendations among the judges interviewed include (see Table 21):
Resources
§ Resources available for parents to get help.
§ Provide adequate resources for dedicated professionals to do their job.

Policy
§ In all cases, the child’s safety should be the paramount concern.
§ Look at all available research, as well as best case practices and determine what is appropriate.
§ Mandatory and combined training and certification on abuse issues for social workers and law
enforcement.
Law changes
§ Statutes are not the problem; it’s the lack of interest if there is no police involvement.
Prosecution issues
§ Ensure that professionals interview the children.
§ Lawyers need to take the time to fully investigate the facts and advocate for the best interests of
children.
Prevention
§ Parenting education in schools.
Prosecutors
The top recommendations among the prosecutors interviewed include (see Table 21)
Resources
§ More manpower to be able to reduce caseloads and work more closely with CPS.
§ It needs to be easier to get CPS reports and information.
§ Need more prosecutors to handle caseload and further investigations that police don’t.
Policy
§ Start with CPS, our biggest concern; again change the focus from unification to protection of the
child.
§ Caseworker should have the discretion that a child is in imminent danger to make a decision
with some degree of amnesty.

§ Parents should not be allowed to refuse services.
Law changes
§ Mandatory reporting law; needs to be less “wiggle room.”
§ Declare pre-natal and perinatal drug abuse to be child abuse.
§ Amend Rules of Evidence to allow introduction of prior conduct.

Prosecution issues
§ What needs to change is the attitude of our jury panel so they understand children are not the
property of their parents.

Prevention
§ More efforts toward prevention, public education.
Police
The top recommendations among the police interviewed include (see Table 22):
Resources
§ Need more manpower/overtime to work the cases on a timely basis, limit caseloads.
§ CPS needs to have more funding and higher pay so they would get more competent caseworkers.
§ Not enough placement options or treatment when you do have to place children.
Policy
§ Better training for patrol; more accountability within department on protocol.
§ Detectives should be able to go out on every case, so that the case can be done properly the first
time.
§ Should have a protocol as a state standard, you could have more agencies working together and
on the state level we could all be mandated to handle cases in a certain way.
§ Policies are there; the problem is that they are not always enforced. We aren’t able to follow
protocol.
§ Child Protective Services should get rid of their 21-day time line to investigate a case and follow
lead of the detectives. The detective should be the first to interview the parent.
Law changes
§ Neglect laws need to be clarified and strengthened (too vague).
§ Need legislation for implementation and coordination of protocols, timelines between CPS and
PD.
§ Another law that needs to be tougher is our stand on substance-exposed babies.
§ Have graduated laws that show the difference between a 16 year old and a 40 year old, etc.
§ The legislation should change the primary goal of CPS to child protection and not have them
focus on the case plan of reunification; rather the case plan should be protection of the child.
Prosecution issues
§ All in all, the laws are pretty tough; we just need to follow them, use common sense, and
prosecute more cases.

§ The county attorney’s office has to take more cases and have a consistent policy when reviewing
cases within the office.

§ False reporting needs to have more serious consequences and be prosecuted.
Prevention
More has to be done in the area of prevention, educate the public, media, and kids about the definition
and scope of child abuse, public information campaign.
CPS Workers
The top recommendations among CPS workers interviewed include (see Tables 23 and 25):
Resources
§ The state must provide adequate human resources to do the job CPS is called upon to do.
§ Community needs better resources for marginal families. Tap resources to parents who have
parenting skills and people who are available to care for kids
§ Group homes should be model facilities as an ideal alternative, bring back good orphanages.
Policy
§ If a mom delivers a substance-exposed baby then she should be mandated to stay in a treatment
program.
§ Value Options must be held accountable for providing timely, quality mental health services
§ The agency must find a better way to serve the needs of families and children and to better
protect children.
Law changes
§ Neglect needs to be more clearly defined, families held accountable.
§ The child should be the biggest priority, not adults.
§ Substance exposed newborns should be specifically addressed by the law.
§ Define “imminent danger” more clearly.
§ Tougher penalties for the crimes committed, laws stricter on child molesters.
§ Remove CPS from DES.

Prosecution issues
§ Better prosecution of abuse cases by county. 100% investigation.
Prevention
§ There is just need for more education, making sure that services are available for these families
and being able to educate the client in all the resources and increase community involvement.
Community Service Providers
The top recommendations among community service providers interviewed include (see Tables 24 and
25):
Resources
§ The first thing – CPS needs more money. The case managers have so many cases, they are
extremely short staffed.

§ Improve competency, training, and retention of CPS workers.
§ Foster parents need to be increased and improved upon with positive incentives and expectations.
§ Improve mental health services. Adequate mental health and therapeutic group homes must be
developed.
Policy
§ Whether law or policy, CPS should be empowered with clear guidelines for removing a child
from a home, should be able to intervene based on a preponderance of facts/evidence.

§ Improve collaboration in the system. Involve professionals in the cases as part of routine staffing
and make sure their concerns are incorporated in the case plan.
§ Change mechanism for children to get medical and other resources needed in a timely manner.
§ Create a team approach to case planning to prevent arbitrary decision-making by CPS, mandated
multidisciplinary teams, more extended monitoring and supervision of cases.

Law changes
§ Neglect and chronic neglect should be clarified and spelled out (presumption of neglect and
abuse).
§ Move beyond reunification for severance or another avenue to keep children safe, balance
between parent’s rights and children’s rights need’s to be reprioritized.

§ Amend the child abuse laws to include substance exposed newborns.
§ More to be done to mandate services and to be able to act on it when a parent doesn’t follow
through, to help the child.

§ Parents should be held accountable and/or prosecuted for abuse or neglect, harsher laws.
§ More should be done in situations where a professional fails to report abuse when they are aware
something is going on.

§ Create clearer roles at CPS and for community providers. There has to be accountability, none as
it stands now. There is no accountability for the judges, no accountability for CPS.
§ Pull CPS out of DES
Prosecution issues
§ The court lacks education regarding substance & emotional abuse and what works with these
families and what doesn’t work. All parties in the system need to be educated on what works.
§ There is not enough information sharing and collaboration among CPS and other agencies and
this can hinder how CPS manages a case and the outcome of a case.
§ Law enforcement and CPS need to improve how they communicate with one another. Maybe PD
can have access to the central registry and CPS can have access some police information. They do not
always cross-refer. It would be nice to see CPS and officers go out together on these calls.
Prevention
§ Funding, health care, spending more on prevention: teen pregnancy, day care, parenting,
substance abuse, and mental health information.

Physicians and Medical Social Workers
The top recommendations among physicians and medical social workers interviewed include (see Table
26):
Resources
§ Improve the quality and skill level of CPS workers.
§ Staff hospitals with CPS workers who understand medical terminology and can be the point
people for the medical team and CPS system.

§ There must be an improvement in resources for safe and adequate discharge planning of
medically at risk kids. CPS must be reorganized, restructured, re-staffed and adequately staffed.
§ Need better education of everyone involved in system. Need cross-training and better
understanding of the role everyone in the system.

Policy
§ Better communication between the agencies and a real collaborative effort between the systems
that would be more of a multi-disciplinary approach.

Law changes
§ Better laws to protect children not parents; make family preservation second and child safety
first.
§ Confidentiality laws must be reviewed. Physicians & hospitals must have access to information
to treat children medically and adequately.

§ There must be clarification of custody/ guardianship statues when abused children are
hospitalized. Legal status must be guaranteed to provide medical caregivers the ability to treat and
guarantee the child’s protection and safety.
§ Improve neglect laws.
§ Harsher child abuse laws
§ Criminalize substance-exposed abuse and give parent ability to plea with services mandated by
the court.
Prosecution issues
§ Better investigations including the use of medical documentation of opinions.
§ With respect to law enforcement, CPS and our work, we should compliment each other and we
could make their job easier and they could make our job easier through collaboration.
Prevention
§ We need to focus on risk factors and prevention. Teaching kids life skills is helpful too. More ads
in media about positive parenting, positive conflict resolution.

Foster Parents
The top recommendations among foster parents interviewed include (see Table 27):
Resources
§ Improve mental health services.
§ Foster parents need more respite time each year.
§ Some children need a special advocate for educational purposes (not just a surrogate parent).
Policy
§ Improve screening of new parents. Perhaps have seasoned foster parents be mentors for
newcomers.
§ Better communication with G.A.L. and child’s attorney.
Law changes
§ Establish appropriate laws and funds to effectively accomplish protection of children, and then
employ necessary personnel.

§ Laws need to provide immediate removal when neglect or abuse is substantiated and drug use is
present.
Prosecution issues
§ Better investigations, quicker removals.
Prevention
§ Change the mental health system to be more “proactive.” Services need to be provided to
people/kids before they are in the “system.”

§ Provide more parenting classes and information and make it mandatory.
§ Everybody involved in system take responsibility to do their job.
Guardians Ad Litem
The top recommendations among Guardians Ad Litem interviewed include (see Table 27):
Resources
§ More case workers are needed and more money for services.
Policy
§ Home should not be preserved at all costs, we wait too long to file dependency.
§ Get all departments together and interacting.

Law changes
§ No laws to be changed need policy changes.
§ Make the parent more accountable for their actions.

Prosecution issues
§ More aggressive approach by the system, to make parents more accountable for their actions, be
it jail or a fine, require more than minimal parenting skills of parents.

§ Courts need more authority to order services.
Prevention
§ Parents must only possess minimal skills – they are way too low.
In Harm’s Way
TABLE 1
Central Purpose of the Child Welfare System
Judges Prosecutors Police CPS Workers
§ The safety and health of the § To protect those who can’t Protection/Safety Protection/Safety
children. * protect themselves. There § To protect and preserve the safety of § To ensure the safety of children.*
§ The paramount concern are different goals for each children.* § To protect kids and ensure that children
should be the safety of the system.* § To protect children whether it is through an have a safe and healthy environment to
children. immediate arrest and to thoroughly grow in.*
§ To seek justice. investigate allegations of abuse.* § To protect children from physical,
§ The protection of victim.* emotional and psychological harm.
§ To protect children. It is a three fold thing: § I also feel that every one is responsible
1.The whole system is supposed to protect for these kids and their safety.
the child particularly the child that doesn’t § The parents are ultimately responsible for
have protection at home. 2. To identify and safety of their children.
prosecute the offender or those that commit § The goal is probably to protect the
crimes against children. 3. Find a way to get children.
abused kids back on track to lead a normal § The main goal should be to keep the
and healthy life. child and family safe and to provide
§ All systems, as a whole, would be sharing a services to help with some of the abuse
common goal which is to protect the child in the family.
whose rights have been violated and to help § To provide crisis intervention. To keep
that child. the children from being in danger of
imminent harm and safe from the
Provide Services/Reduce Trauma immediate danger. It is a very narrow
§ To reduce further trauma and to empower the focus, as we are the responders of last
victim. To hold the perpetrator accountable resort. However, this is muddy because
and also to prevent further abuse.* of different factions in how the county
§ To stop child abuse. To provide services to the and agencies see us, which is in very
family and to aide in the prevention of abuse. different roles and it leads to role
§ Assess victim’s needs and tend to them. confusion.
Successful Prosecution Provide Services/Reduce Trauma

§ To prosecute offenders.* § To prevent generations of CPS families;
§ To assist in the prosecution of cases we think stop the pattern.
we can win. § In social services, it is to provide services
§ To prosecute those offenders who have to the families.
committed a crime as far as the system goes:
to have an investigation prepared to the Keep Families Together
fullest extent and assess what ever needs the § In my agency, the goal is to provide
victim has and tend to those needs. It is the services to families and try to preserve
same thing for CPS. families and if that is not possible, to try
to reunify families or move children to
permancy.*
§ We are a family centered practice.*
§ In our case plan, our first goal is to
preserve families and to set up a plan to
reduce the risk factors in order to reunify
the family.*
§ We make sure that each case is dealt with
expediently and in a proper manner and
that each family has the opportunity to
follow a case plan.
In Harm’s Way
TABLE 1 Continued…
Central Purpose of the Child Welfare System
Foster Parents Community Service Providers Physicians & Medical Social Guardians Ad Litem
Workers
Protection/Safety § The whole system is so disjointed right now that you Protection/Safety § To get out of as many cases
§ To protect a child from can’t look at it as one system because it doesn’t work § To ensure child safety and to as they can without meeting
abuse and to provide a as one system. find a nurturing home for every the needs of the children.
supportive, safe and loving § To process cases with as much efficiency as possible. child. § 1. Protect Children 2.
environment for them to § It is to ensure child protection Reunify Families. 3. Find
grow up in.* Protection/Safety within the context of the permanent placement.
§ To protect children.* family. § The stated purpose is to
Provide Services/Reduce Trauma § To assure a child’s safety and give the child an § Child protection and family protect children – We don’t
§ To advocate for services. opportunity to become a self-reliant and productive reunification.* do it very well, we are
§ To help a child recover from citizen. * ineffective.
trauma. § To ensure a safe and nurturing home for every child. Prevention § Family Reunification
§ To prepare them for their To prevent further abuse and to promote the § In reality, the current system § It is supposed to be to protect
next placement. development of healthy children. seems to react in a manner that best interest of the child.
§ To give encouragement and § First and foremost, I think it is to protect children. has the least impact on scarce
provide a child with a sense § To protect kids and to try to make the best out of each resources.
of family. situation. § The prevention of further
§ To prepare a child to § To assure the safety of children. To find out and then abuse. To promote the
become a productive advocate for what’s in the child’s best interest.* development of healthy
member of society. § Ultimately, all of us want that child to be in a safe and children.
§ To provide education for the permanent home, whether it is law enforcement, CPS, § The primary goal of the CPS
child. the courts, etc. We would all be working toward the worker should be to be
same goal. proactive. We should be asking,
§ To make children safe. To remove them and put them “What are the risk factors?”
in a safe place. I think all of the systems try to work Let’s put our money there
with each other. because it is so much more cost
§ It is the system’s responsibility to protect children and effective than to try to fix the
to provide services that are in the child’s best interest broken families.
and not do what is always the easiest or take the easy
way out.
§ The system provides a check and balance for
everyone to be dealt with fairly.
§ To determine if abuse has occurred.
§ With all systems: it is to keep the child safe and to
help the child find a stable environment.
Provide Services/Rehabilitate
§ To assure a balance between parental rights and the
rights of a child in order for the child to be safe at
home. *
§ To provide parents and children with necessary
resources. To prevent against future abuse and neglect.
§ To provide treatment and legal representation to
parents and kids.
§ To try to help families, educate them, and help them
learn the skills they need.
§ I think that trying to get the services through Value
Options is a problem. Trying to get CPS and
behavioral health to work together is a problem.
§ To rehabilitate offenders.
Best Interest of Children

§ People need to be more aware and focused on what
each other’s missions are and they all need to focus
on the best interest of the child.
§ I think that CPS’ sole purpose should be to look at
what is in the best interest of that child while that
child is still young enough to have a future.
In Harm’s Way
TABLE 1A
Should be Central Purpose of the Child Welfare System
Judges Prosecutors Police Foster Parents Community Service Physicians & Medical Guardians Ad
Providers Social Workers Litem
§ The safety § To ensure the § First, the goal § To protect § The protection of § To protect children § Remove
and health safety of the should be to children and children and what is in at all costs. Family children from
of the children.* protect the child. provide them the child’s best interest.* preservation should unsafe
children.* § The primary To make sure that with a good § To ensure the safety of come second to that. situation and
§ The goal should we provide education.* the child. * * don’t return
paramount be the services to the § To focus on § To reprioritize child § To ensure the safety them until it
concern protection of victims i.e. the best safety over the rights of and the well being is safe be sure
should be kids. CPS is medical and interest of parents.* of children.* they are
the safety concerned counseling. To the child. § For some people, the § To create a better placed in a
of the about provide the § 1. To rescue goal is to protect parent’s balance: children’s safe foster
children. protection victim with children who rights but that should rights first, then home
§ To seek but the resources to are in a never be the goal. parent’s rights. The § Provide
justice. emphasis on ensure their crisis. 2. To § The primary goal should welfare and safety services for
family safety and to reunify be to find a strong and of the child should the family to
unification. It prevent the abuse families. 3. stable home with which be the number one keep them
isn’t always from happening To find the child can live and priority.* together in
the best way to them again.* permanent grow up in. It should be a § Better the healthy
to go about § CPS seems homes for healthy and strong stable collaborative efforts environment.
it. confused on their abused kids. home. between all of the § Place child in
§ The purpose. As it § Minimize the § CPS should be able to agencies to ensure a safe loving
presumption stands now, CPS time for the place these children child safety.* home.
of family has a bigger removal of sooner and not give § To provide
unification interest in children. It parents chance upon necessary and
isn’t the best reunifying should be chance to get the child appropriate
presumption. families.* after the first back, especially when resources to ensure
It should be § We focus too substantiated they have not done child safety. Child
the much on getting allegation of anything to comply with safety should be
presumption the suspect put abuse. Then, the case plan.* evaluated on a
of child away but I think provide them § CPS needs to look at all case by case basis.*
protection. of the children with an out aspects of abuse § To remove the
and what is going of home (physical, sexual, barriers. We
to happen to placement to emotional abuse, and shouldn’t have to
them.* nurture them, neglect) which can all be wait for approval
§ It is really hard to aid in just as damaging to the from CPS to give
get these kids repairing child. To protect children care to a child and
counseling and them exposed to drugs and provide forensic
force them to go emotionally, alcohol. According to medical care. AHIT
back and live in and help CPS, substance abuse is never calls us and
their same them to a lifestyle choice. Drug even when we call
environment. prepare for use is not considered them for approval to
Maybe getting their future. abuse or neglect. conduct a forensic
them out of their § To protect § To keep children safe. exam on a child,
environment and children and Abusers who abuse they say no.*
placed into a provide them children get less prison § A multidisciplinary
safer one would with a safe time than abusers do, team approach to
really help these home to who abuse animals. We protect the child. A
kids. grow up in. need changes in the better quality
§ To get a criminal system. assessment tool for
case through the § To provide better targeting at risk
system from the resources to ensure child families.*
beginning to end. safety. We need better § Family preservation
It is all about services for prevention & and kinship care
making sure the intervention.* should have better
kids are taken § To protect the child and defined policies to
care of. to have some kind of deliver quality
§ To take a stronger punishment inflicted on intervention. There
stand and to stop the offender; in a larger goals should be
having lame plea sense, to protect of the specifically targeted
agreements. They community from the to address the issues
need to be sterner offender. that can be
and offer the § The definition of the realistically resolved
toughest pleas. minimal parenting in order to produce
§ If you don’t have standard must be better outcomes and
the person changed and enforced. improve child
indicted in a We need a higher safety.*
reasonable standard, in its current § To be child advocate.
amount of time standing, it is less than § We need to preserve
they can be minimal.* some families; but
released. § To either reunite a child we also need to put
§ The goal is not with a natural family or a child into a
being met with put the child up for nurturing home and
other agencies adoption. sometimes it is not
such as CPS § There must be better with the family. The
because they communication and child’s needs should
don’t have the collaboration among the be the focus.
resources to meet agencies to ensure a
their goal. Some child’s safety.*
agencies don’t § Right now a parent can
have the refuse to talk with you,
manpower to so how can that
meet their goals. constitute an
§ Everyone should investigation?
be striving to § To truly investigate
achieve the same allegations of child
goal. abuse.
§ To make sure that the
time that someone is put
away is commensurate
with the crime.
§ To go beyond protecting
the child and serve the
family.
§ Ideally, it is to provide
services for the
protection of children
and individuals, to help
keep them safe and to
help them overcome
barriers in their lives, so
that they can become
productive citizens.
§ To protect children and to
support families. The
paramount goal needs to
be: to assure children are
safe and that they have
an opportunity to be self
reliant productive
citizens in the future.
In Harm’s Way
TABLE 2
Organization’s Current Mission or Purpose
Judges Police CPS Workers
§ Abuse and neglect are § To investigate child abuse and sex crimes. § To ensure the safety of children. *
considered in deciding custody To investigate allegations of abuse or § To strive for permanency: we try to provide services to families to keep the
and parenting time. The family incidents of abuse. To aid in the child’s permanency in the family if at all possible. *
court may ask CPS to prosecution of crimes committed against § Reunification/relative placement *
investigate if there are children. * § Overall, ensuring the well being of the children in our care is our goal; I’d
allegations or evidence of abuse § The protection of children and to be able to say we accomplish it about 50% of the time. *
or neglect. do something for these kids when they § CPS strives to achieve all three goals: safety, permancy and well being.
§ Child abuse and neglect are come forward and disclose the abuse. To § To investigate allegations of abuse and to ensure the safety of child
prosecuted as crimes in criminal be able to prepare for a successful § We strive to move children out of the system.
court. prosecution and limit the future trauma to
§ Severance/adoption is the last resort in child protection.
§ A person who is charged with the victim. *
§ Placing children for adoption and striving for permanency is our goal.
abuse or neglect comes before § To provide an interdisciplinary approach in
the judge to resolve the charges. the investigation of child abuse or neglect. § We can only provide for the needs of children if our contractual homes and
service providers do their jobs well and provide these children with quality
§ To reduce further trauma to victim and to
care.
have a successful prosecution.
§ In central intake, we are very organized and the quality of our interaction is
§ We have to be able to respond in an
impressive and essential.
appropriate time frame because the longer
you wait the less success you have in § I do believe that we strive for the goals of safety. In investigations, we assess
prosecuting the case and having the case the child’s safety and we have 100% response rate.
followed up correctly. § We look for safety in foster care placement and in the biological home and
when the child is to return home we continue to assess safety once the child
is in the home until the case is dismissed in court.
§ We use reunification services and family preservation programs. We assist
families in connecting with community services if we are not going to keep
the case open or make the child a ward of the court.
§ The job of CPS is to go out and assess the family environment and make sure
the children are safe. We establish permancy as soon as we can. It was quite
possible for a child to live in their home without a disturbance, after we
made an effort to reunify the family. For the goal of child well being, we
strive for family reunification; we try our best to make sure that children go
back to live with their family.
§ Our job: within a year, we determine if we should go for family reunification
or severance based on the parents’ response to our case plan. The plan
includes the therapeutic recommendation. We try to find foster homes and
adoptive homes for the children in case we do go for severance. In most
cases we try to find a family member or guardians to keep the children in the
family.
§ By responding when we hear a kid may be at risk, we have pretty good
system in place when we know we need to call people to go out if the kid is
in danger.
§ By moving the case along as quickly as possible, we try to provide services
for the parents so they can get their kids back.
In Harm’s Way
Organization’s Current Mission or Purpose
Community Service Providers Physicians & Medical Social Workers Guardians Ad Litem
§ We advocate for the victim’s rights. * § To give the best possible care to § To advocate for the child’s best interest.
§ We work on building and strengthening families for children * children and their families. * *
§ Child Help USA is dedicated to the prevention and to the treatment of § Maricopa County Health Systems: § To talk to the child if possible and to
abused children.* Mission is to care for AHCCCS talk to the guardians or the parents. To
§ EMPACT Mission: To build strong families and communities by helping AZ patients and undocumented inspect where the child lives and to
youth and adults cope effectively with the challenges of life. This is pediatric patients. 75% of patients obtain necessary records such as,
achieved through compassionate and innovative prevention, counseling, are Latino. medical and educational records. *
crisis, and training services. § St Joe’s mission is to basically take § To follow rules of procedure set out by
§ East Valley Child Crisis Center: We believe in focusing on little kids, giving care of and treat all patients who are Supreme Court. As GAL I need to be
shelter and on strengthening families and community education, awareness, in need of medical treatment, familiar with child and child’s case.
and prevention. especially the most vulnerable in § Follow Rules of Professional
§ We serve all victims of sexual abuse, physical abuse and neglect and not our society.* Responsibility.
only do we serve victims but their families as well. Part of what we try to do § To provide hope and healing.* § Defend the child’s best interest.*
is not just to provide the services to these families, but also, to provide § We treat all patients who are in need § To assess the child’s placement for
solutions and prevention resources.* of medical attention.* appropriateness; assess the caretaker;
§ Basically to empower battered women and their families and to prevent and § To provide excellent healthcare to determine if the child is well groomed;
stop domestic violence. inner-city, poor, insured and determine if the child is suffering from
§ To provide support for DES and to provide stability for the family uninsured patients.* any trauma.
§ CASA: It all comes back to the same thing it is what is in the child’s best § To provide safe discharge plans for § Determine the child’s needs, physically
interest: protect the child and keep the child safe. To give the child as many medically needy or at-risk children look at the child for abuse or neglect,
opportunities as possible to help make sure that the child can lead a healthy or children who have experienced and look at the child’s surroundings.
and productive life. To keep the child safe.* health problems, abuse or neglect.*
§ To recruit and train community volunteers to advocate for the best interest of
the children who are wards of the court. We work with kids that have been
abused and neglected.
§ Local School: Promoting self-proficiency. Our job is to help them to become
better. To help families get off of the welfare system.
§ JFCS: Strengthens the community by helping people find solutions to
different life circumstances. To help families in a variety of ways.
§ The mission of West Valley Child Crisis Center is to provide temporary
shelter and supervision for children who are victims of, or at risk of, abuse,
neglect or abandonment, in a safe, nurturing, home-like environment staffed
by quality care providers and to interact with the community to increase
awareness of, and work to prevent, the cycle of child abuse.
§ To give the best possible care to children. To provide hope, healing and the
best possible care to children and families.*
§ End the cycle of domestic violence by providing a variety of resources and
education.*
§ To be a part of the support system made available to victims.
§ We provide foster case management.*
§ We are a direct Service/residential care provider to juveniles who have fallen
through the cracks.
§ Our agency reviews foster care placements.
§ Ombudsman: To make state government more responsive to citizens and to
be sure that the agency treats citizens fairly.
§ Victim Advocate: To assist victims during the criminal justice process by
educating them, empowering them, reducing trauma and we provide needed
resources to other agencies.*
In Harm’s Way
TABLE 3
Central Purpose or Primary Goal of Individual
Judges Prosecutors Police CPS Workers Foster Parents Community Service Physicians & Guardians Ad
Providers Medical Social Litem
Workers
§ The primary § We don’t § Investigate to § To place a § To nurture § To be an § We § Being a
goal of necessarily see if a crime child in a safe and give advocate for the evaluate GAL is the
family court see eye to has been environment. guidance, children. To and treat only true
is stated in eye on CPS committed * * love and find out what is children neutral
Rule 6, and what § Investigating § My goal is to compassion. in the best and person
Maricopa Co. their goals and gathering preserve and * interest of the families in acting in
Local Rules are. Our all of the unify the § To provide child and to see cases of child’s best
of Practice. goals are facts in an family.* protection. * how it is carried abuse.* interest.
§ Fairly and different than unbiased § To make sure § Create a out.* § We Make sure
impartially theirs. I think report and I assist desire for § To recruit, train provide case plan is
administering we are more determine if workers in education. * and support healthcare appropriate
justice while focused on a crime has investigating § To be a volunteers and to meet and carried
attempting to the protection been child abuse nurturing families.* the needs out.
“search for of the child. committed. allegations and caring § To provide of Looking at
the truth” CPS’ focus is § Investigate and to ensure role model services to patients.* long term
§ To ensure the on family crimes that they and try to strengthen § We best
best interests reunification against know how to understand families and to provide interest.
of the and a lot of children, deal with what the prevent abuse.* advocacy § Advocate
children are times we sexual physical foster § To help families and for child.
being met. don’t feel assault, and abuse and child’s and consumers resources § Advocate
that the focusing on neglect.* needs are reach a higher to for best
family should what is best § To create and address level of patients.* interest of
be unified. * for the child. permanency them. functioning.* § To provide child and to
§ To prosecute § To close for the child § To teach § To protect high facilitate
child crimes cases and not § My unit is children children.* quality the
and, in order get long term their own § To provide medical placement
to file complaints. foster worth and excellent care care to § Act in best
charges on § To reduce placement; respect for for children children. interest of
someone who further we still focus others from birth § To provide children.
has trauma to on § To be a through age 12 a safe § Watch out
committed victims of reunification positive role who have been discharge for kids
child abuse, crime, even when model and abused and plan for best interest
we have to utilizing a kids are in give them a removed from our
believe that multi- long term positive the families or patients.
there is a disciplinary foster care. experience the families § We
reasonable approach. § To remove that they can have been in a provide
likelihood of § To protect children from take with crisis.* emotional
conviction children and abusive them. § To ensure that a support to
and there has make sure situations. § To prepare child has trusted families in
to be they are not § To take the children for adult to see on crisis.
probable re- best report I independent long-term basis. § To identify
cause to be victimized, can and living. § To provide and help
able to whether it is present the children at
monitoring to
charge them child abuse, information risk.
the home in the
with a felony. neglect or in a clear, least restrictive
* sexual abuse. compete and environment.
§ To seek § To put the precise § Use a family
justice. evidence manner. systems
§ To ensure together and § To try to help perspective, and
victim’s prepare an the families look for the root
rights. appropriate that needs it. of the problems.
§ To seek report for the § To support
references county victims of crime
and provide attorney for and help them
assistance to review and with their
victims. hopefully, immediate
§ To comply they will take needs.
with the case and § To interview
“Mission push for a children
Statement” of successful regarding
the County prosecution. allegations that
Attorney’s they have made
Office. or disclosed to
§ We have a someone
high standard regarding
to meet in the sexual abuse,
prosecution physical abuse
of cases. In or neglect.
our office, it § To identify and
is a team prevent the gaps
approach. in the system
that prevents
justice to
battered women.
§ Certainly the
basic goal is to
get information
out about child
abuse and
neglect and the
need for
community
involvement.
§ To help families
to be self
sufficient with
employment
once the family
is “family
sufficient.”
§ To assist callers
the best way we
can.
§ To identify
problems in
CPS’
procedures and
policies and
recommend
changes. To
identify the
problems
through
investigating
complaints on
an individual
basis.
In Harm’s Way
TABLE 3A
Should be Central Purpose or Primary Goal of Individual
Judges Prosecutors Police CPS Workers Foster Parents Community Service Physicians & Guardians Ad
Providers Medical Social Litem
Workers
§ The primary § To protect § To investigate § Our main § To nurture § To build and § We make § To
goals of the children.* sexual and goal is child and give strengthen every advocate
family court § To seek physical abuse. safety and guidance, families for effort in for the
are stated in justice and to * protection.* love and children, to help being best
Rule 6, pursue the § To protect § We help compassion.* families and proactive interest of
County Local investigation children. * families to § To help consumers reach in trying the child.*
Rules of of the case. § The most try and create a a higher level of to address § To get to
Practice. To see the important goal is provide a desire for functioning.* the risk the
§ To ensure the case through to make sure healthy education.* § To find out what factors. children
best interests to the end. these people are environment § To provide is in the child’s We try to early; stop
of the § The successfully for their protection.* in the best identify a second
children are prosecution prosecuted and kids.* § Provide a interest and go early on generation
being met of crimes not to push § To create positive role after it whether families of
§ Fairly and against paper. To ensure permanency model and it is foster care, and following
impartially children. that children are for the experience to adoption, stay children in the
administering § I think all of first and child.* take with with parent.* who are at parent’s
justice while us would like foremost § Finding the them.* § Whatever the risk and footsteps.
attempting to to feel more protected. * balance § To teach family needs to we work § To make
“search for confident in § To keep the between children their prevent child with other sure that
the truth”. our ability to investigation as enforcement own worth, abuse in the people to the child
protect unbiased as you and keeping respect for home.* try and is getting
children but can. families others § To recruit, train develop the
the way § To investigate together § Prepare and support initiatives services
things are crimes against whenever children for those volunteers, to try to they need
structurally children by possible. independent social workers prevent without
set up with using a § To prevent living. that serve abuse.* all of the
CPS multidisciplinary generations § Try to children.* § Our focus red tape.
controlling team approach. of CPS understand § To is on § To see that
our ability to § To safeguard the families and what the advocate/support children’s every
keep abusive children and to stop the foster child’s victims of crime healthcare child is in
parents away protect the pattern of needs are and for their and a safe and
from their community. abuse. address immediate safety.* loving
children § To help kids. I § To try to help them. needs.* § To protect home.
during the don’t know if the family.* § To interview the child
pendency of the cases are § The safety of children in the
criminal being done children; we regarding future
prosecution justice, we don’t have the allegations that from re-
is somewhat have the time to responsibility they have made abuse but I
limited. devote to them to reunite or disclosed to would like
§ I think the that they them in some someone in a to see an
reality is that deserve. There way with regarding sexual overall
CPS grants are cases of kids their family. abuse, physical goal of
reunification falling through § To be a abuse or neglect; reducing
during the the cracks. critical prosecute and childhood
pendency of § To reduce thinker about incarcerate injury.
a case, that is further trauma to discerning abusers.* § To
going to the victim, even elements of § Protect victim advocate

occur though it is a reunification. from being for our
whether we secondary goal. § Protection further patients
think it is § Informal goal; to and traumatized. and
appropriate educate the reunification § A larger provide
or not. public, children can pose a responsibility is resources
§ It is also a and adults in conflict; you to try to help to them.*
philosophical what child abuse have to make the system § To be able
question, our really is. weigh the better and to
job is to do § We should be pros and the stronger so the collaborate
criminal looking at cons of the kids can be in a better with
prosecution protecting situation. I home sooner and other
of people we children and we wonder if we a safer home, agencies
believe should work should be a one that is so we
violate the hard to put the child supportive of a don’t
statutes, offender away. centered child. duplicate
while we § To keep children practice § Just placing a our efforts
would like to safe. instead of a child in a home and are
ensure the family is only the first able to
safety of the centered step and we make good
children, practice. need to make use of our
statutorily it § This is a sure the services resources.
is not our parent’s are there for the
primary goal, rights state. I child to stay in
although it would say it that placement.
can be very is the safety
frustrating. of children.
§ When a court Let’s really
orders no make
contact, there protection a
is no one priority, big
going out to time.
make sure Reunification
that it would be
doesn’t fifth on my
happen. If list.
CPS isn’t
involved,
there is no
one going
out to see if
that is
happening.
§ Make sure
the victim’s
rights are
being
upheld.
In Harm’s Way
TABLE 4
Personal Interest and Expertise
Prosecutors Police CPS Workers Foster Parents

Interest: Interest: Interest: Interest:
§ Clearly it is the most rewarding § It has always been an interest of mine.* § I care about children and wanted to do § I was working at a
prosecution that there is, when you § I realized I liked working with kids and work that is meaningful. children’s shelter and
have child victims and you are I wanted to help the youngest victims § I enjoy working with the community realized that a lot of
protecting children. who are the most vulnerable.* and knowing that I am making a children needed foster
§ I began working at the Domestic difference with each family. homes.
Training: Violence Unit and found it interesting. § I’ve always wanted to work with people.
§ More training is always better. After that, I wanted to work here. § It is my desire to want to learn more Training:
§ We should have a general medical § I always had an interest in kids; I used about child welfare. My number 2 § Minimum 12 hours a year
library here. to be a resource police officer at a desire is to be able to work with required training on topics
§ Domestic violence, sexual assault school. families who have many needs. related to foster care.*
and staffing seminars for shaken § Investigations have always been an § After I received my social work degree, § Training on
baby syndrome-maltreatment. interest for me and it is what I always I went out to save the world. communication, discipline,
§ Child abuse seminars. wanted to do. child development and
§ Forensic interviewing seminars. § When I have a real live victim and I can Training: working with other
§ Training on neglect cases and how make a difference in their life, then, that § CPS Pre-core and Core training.* professionals.*
to prosecute. is what really matters. § I would say the training that the agency § Classes attended on child
(DES) makes us do is completely behavior.
Training: useless.* § All services available to
§ Child maltreatment training. § Residential treatment for teens and foster parents should be
§ 40 hours forensic interview training. children.* published
§ Training on handling
§ Child pornography. § Forensic interviewing.* aggressive behavior.

§ Computer crimes. § We need more hands on field § Feel I was adequately
§ Child homicide. training/mentoring.* trained.
§ Burn training. § CPS experience in Florida system. § Past experience includes
§ Medical aspects of maltreatment. § Foster care case management. working in mental health
§ Shaken baby syndrome. § We need more training in medical field & pre-service training.
§ Interviewing and interrogation training. terminology and child maltreatment.
§ Domestic violence training. § Preschool education.
§ Child sex exploitation training. § Court training.
§ Training is becoming more and more § CHILDS training.
available. § Training specific to policy, effects of
§ Not enough training. drug use, effective case plans, case
§ Yes, could always use more training. management and cultural diversity.
§ Lots of training, basic and advance. § Have received adequate training.
Budget concerns-can't go to all the § Montessori teacher, masters in social
training you want. work.
§ This department has a very strong § I think we are on the right track with our
emphasis on learning new skills and in training institute.
training. § Bachelor’s degree in justice studies and
§ Training is emphasized to sharpen your a Masters degree in Psychology.
skill and be able to be better educated § I think I have received more training
in the areas that you are working in. than the other workers. I think that the
§ When I first arrived I had no training training the state offers is excellent and
and it was ridiculous. I think we do a much better than what other states are
lot better now. doing.
§ Training is a continuing process and § Needs to be more training in policy,
with our with budget problems, we are extra case management classes/ court/
slowing down on out of state training. policy/ hands-on. The problem is in
§ When I came here I got some management and training.
immediate training but it took a while § You never feel you received adequate
to understand child maltreatment and training in child abuse.
how to handle child crimes.
§ During the course of being at this unit, I
have received a lot of training. It comes
down to money. Currently, funding is
limited.
§ I received a lot of training formally and
informally on the street. In this unit no
one can truly prepare you for the
sensitivity you have on these cases.
In Harm’s Way
Personal Interest and Expertise
Community Service Providers Physicians & Medical Social Workers Guardians Ad Litem
Interest: Interest: Interest:

§ My desire to help people and to be treated, as I would like to be treated § I help families navigate through the § I was brought out of retirement to
in a crisis situation.* system. establish this unit.
§ I like working with people, especially families and children.* § We maximize the child’s protection and § I enjoy juvenile law.
§ I had a passion for kids, children and families.* advocate for the child.* § My desire to help children.
§ To protect children and look out for their well-being.* § It is caring for children and wanting to
§ I like talking to kids and relating to them and helping them to meet make a difference.* Training:
their needs.* § I took the child abuse job and I ended up § Did not receive adequate training.*
§ I like working with little kids and the CPS system even though it is a finding it to be very rewarding. I have § Did receive adequate training.
horrendous task. been in the field ever since. § Law Degree, significant study in
§ I was interested in the field of counseling. psychology, my husband is a
§ I have always worked for the underdog. Training: psychologist.
§ I wanted to be a social worker ever since I was a child. § Pediatric medical social work. § Law Degree, in law for 20 years.
§ I have always worked in the field of child abuse prevention. § Substance abuse assessment. § Law Degree, on job training/self
§ I have been given the opportunity to serve more kids than I would have § Developmental and family systems training seminars.
if I had chosen any other venue of social work. expertise. § Law Degree and on job training.
§ My experience is in educating and supporting parents. § Medical healthcare of children. § Court appointment for 20 years.
§ I followed in the footsteps of my family. They have always been into § Providing assessments, education and
the field of Social Work. understanding the impact of acute and
§ You learn something all the time. Kids make you feel accepted. I enjoy chronic illness in children.
the happiness I get out of working with children. § Would be experts in training other
§ I believe parents need support and help through the most difficult job agencies and professionals in child
we have, which is parenting. abuse.
§ To empower people who are dealing with a basic crisis and I get a lot § Expertise is diagnosing child abuse and
out of helping people with extreme vulnerabilities, I find it rewarding. neglect.
Training: § Prevention, health, development, and
general well-being of children. In
§ Adoption adjustment issues.* general, pediatric medicine.

§ Being able to withdraw information from people unwilling to give it. § It is critical in understanding the other
§ Normal child development and the problems and consequences of discipline’s roles in working together for
neglect and abuse. the protection of children.
§ Would like contacts with County Attorneys and CPS.
§ Understanding the child welfare system.
§ Care and keeping of community volunteers.
§ Foster care/adoption worker.
§ Counseling.
§ Child advocacy.
§ Juvenile probation.
§ Mental health.
§ Master of Social Work.
§ Foster parent.
§ Parenting Educator.
§ Youth Development theory expertise.
§ Criminal justice.
§ Social work.
§ Counselor.
§ Expertise is supervision of behavioral management teams with children
and families.
§ Master’s is in clinical psychology.
§ Understanding the child welfare system within AZ.
§ Retired school teacher.
§ Diverse background when it comes to abuse and neglect issues.
§ Bachelors in education and a Masters in communication.
§ Been involved in Child Welfare for 25 years.
§ Domestic Violence and Child Sexual abuse experience.
§ PhD in Psychology.
In Harm’s Way
TABLE 5
Interface with CPS
Judges Prosecutors Foster Parents Community Service Providers Physicians & Medical
Social Workers
§ We have CPS § Usually, if there is an § Once a month contact § We accept children from CPS for placement.* § When CPS suspects
workers testify arrest made then the with the child.* § We interface with CPS when a child is involved abuse, they come to
in criminal, police may contact § We have little contact with in a court action.* us to ask general
family, and them. If we file the GAL.* § I assist callers in contacting CPS. We refer questions and
juvenile courts. charges and an arrest § I have little contact with callers to them.* request evaluation of
§ To be active and has not been made, child’s attorney.* § We call CPS when they need to take a report, child.*
manage cases to then CPS may not be § The worker provides me when we need CPS to take guardianship when it § Work together to
achieve the involved. with good information becomes necessary. provide safety
results necessary § Usually when the and good § CPS is housed within the same building and they solutions for child.*
for the child. police make an communication.* go out of their way to help out. § Call CPS hotline
§ They attend arrest, they are § Some CPS workers try to § We have developed a good relationship with when we suspect
regular hearings supposed to cross make an effort to see the CPS. We work hard with workers who are abuse or neglect.
to ensure the refer to CPS. They foster children once per completely overwhelmed and we help them to Interface with CPS
requirements are always do when they month. Other workers go do their jobs by assisting them in getting things when children are
being met. have to get the months without seeing the done in their caseloads. hospitalized. Work
children in the home child. § We work very closely with CPS in staffing with CPS to
placed. § Some case managers don’t assignments and attending court hearings. discharge children to
§ We always request visit often as they should Additional activities include working with the safe placements.
the CPS record and (up to six-month lapse). case manager in reviewing what is going on in Work and treat
we get back a § Our licensing agency the child’s life and interviewing other people children who are in
response that there is works well with CPS. related to the child. the care of CPS or
no record filed with § There is minimum § We are working hopefully, toward similar goals. are being case
CPS. That is how we managed by CPS.
connection with the child § Our community volunteer’s support a child
know CPS is or is during placement. victim and they interface with CPS caseworkers. § Referrals are made
not involved. CPS for physical abuse,
records are not user
Interestingly, contact with § If there’s a case involved in the classroom, I
the child typically occurs sexual abuse,
friendly. follow up and see what kind of service to
right before court and medical non-
provide for the family.
§ It is CPS’ job to compliance,
notify the police or
when the case is going to § If any kind of incident should happen we let CPS medically at-risk
be heard at the Review know right away. If we disagree with the case
vise-versa. Board. Many CPS case children, failure to
plan then we contact them to talk about it.
§ Ordinarily the CPS managers act like they are thrive infants and
case has been closed § We have a child protection hospital based team toddlers, and
not very interested or “too with CPS and we discuss the cases and the team
before the case busy” to be concerned statutory rape.
reaches this stage. will generate a letter when a case is of § We also work
about a relationship with paramount concern and they are not in
the foster child. together to come up
agreement with the case plan. with solutions for
§ Their visits last § We serve as a liaison between CPS and foster
approximately one hour some of the child
care placements. protection issues
with the family and they § CPS provides us with information on a child’s once it is determined
have a separate time for progress in out of home placement and that they need
the child. reunification efforts. protection.
§ At times, the interests of § Retrieving case information and assuring the § Mandatory reporters.
the child are not their caseworker is established with the case. § Continued contact
priority. § Collaborate with the CPS staff to assist children during follow-up.
who integrate into new families. § It is frustrating when
§ We engage in collaborating with CPS to increase CPS who won’t hear
their skilled workforce. what we are
concerned about and
§ Frustrated With Contact won’t consult us
§ In interfacing with CPS, there isn’t as much regarding their plan
teamwork. There are barriers to how we and won’t share what
interface with one another and there could be they are doing or
much more team work to help these kids. what the plane is,
§ There are a lot of CPS workers who do not have which ultimately
the knowledge base to do the job. affects our plan and
§ Basically I attempt to stay in touch with the case we find this to be
manager on a weekly basis there are weeks that I very difficult and it
don’t see her. is not in the child’s
best interest.
§ Generally, I get my referrals primarily from Law
Enforcement and CPS. Personally, some workers
are good and others have no business being in
the field.
§ We communicate to CPS regarding our referrals.
It is frustrating when there are workers who
won’t hear what we are concerned about and
won’t consult us regarding their plan and won't
share what they are doing or what the plan is.
§ Contacts often lost.
In Harm’s Way
TABLE 6
Opinion of CPS
Judges Prosecutors Police Foster Parents
§ To investigate and evaluate § Their goal should be to § To protect children but they place too much emphasis on § They need to increase
allegations of child abuse protect the children from reunification of the family.* their level of respect for
and neglect.* harmful situations but the § To protect children from abuse, neglect, provide services foster parents.
§ CPS is overloaded with their emphasis is on family and remove if necessary. Sometimes case managers
caseloads to do an adequate reunification.* § To protect children and to do a parallel investigation with have a bad attitude.*
job and seems it will only § Their job is unification of the police department. § To offer training and
get worse with current the family unit as opposed § To build the family back together or protect the welfare of support.*
budget problems.* to the traditional goal of the the child involved.* § They are not adequately
§ CPS lacks the resources to protection of the children trained and should
investigate further. and that is what they have Goal conflicts establish a higher level of
§ I would rate the performance told me so they recognize § It should be to protect children. It is to reunify the family as knowledge for case
of CPS in court as adequate that we have different goals. I understand it. I see this as a conflict. managers. They also need
considering the available § Therein lies the conflict and § Protection of the family and reunification is a double edge to develop appropriate
resources. not all child protection sword. It is a dual mission that is not attainable. pay scales to minimize
§ Protection of children that workers want it that way but § There primary goal should be safety over the preservation of case manager turnover.*
doesn’t necessarily mean they have stated they feel a families.* § The biggest role of CPS is
keeping the family together. lot of pressure to reunify § They are on a different timeline than us, and because there is to place a child in a safe
§ CPS is too careful about and a pending criminal case only so much that we are able to get to, the investigation can home and monitor the
issues of confidentiality. is not a good enough get spoiled if we aren’t able to do the initial investigation.* child once a month.
§ reason.*
There is a problem with § CPS’ 21 day timeline is often too short, resulting in not
government in general; too § CPS is too focused on enough time put into a case and a decision to substantiate or Issues:
many chiefs, not enough reunification than what is not to substantiate abuse to be made with sometimes not § They need more available
Indians. best for the child.* enough evidence collected to make a determination so counseling and
§ CPS needs more foster § Their goal should be to quickly, this results in the police detective substantiating a psychiatric services for
families. protect children at all costs, case well after CPS unsubstantiated and closed the case.* the child.*
§ I think CPS is doing a fine not reunify families at all § CPS is to protect child safety and focus on family § CPS leaves the
job. If I need records, it costs. reunification whereas ours is to put bad guys away. responsibility of child
promptly responds to a § You have workers who are § CPS places children with relatives who are just as bad as the stability up to the
subpoena for a camera making critical, potentially offender. They place a child with a dysfunctional family licensing agency or
inspection. If a case life and death situation member.* worker.
manager, they respond to decisions, which are grossly
§ Often the child is left in the home with a caretaker or placed § Stability is greatly
the subpoena and testify to overworked, grossly under decreased if case
with a relative placement and the plan offers no protection
the information that is paid and grossly under managers keep changing
for the child. The caretaker or relative can’t or won’t protect
available. educated, it is a recipe for for the child. They have a
the child from the offender or keep the child away from the
disaster. high turn over rate.
offender.*
§ Whatever assessment tool § The case manager’s
§ I have no problems with the way CPS does there job. They
they are using it is not schedule needs to
have to put the child with the family. They do not have
working. They are accommodate both the
evaluating situations they enough resources. foster parent and the child.
have no clue about.
§ We need to work more Relationship problems
closely with CPS, I do have § Some of the CPS investigators will go out of their way to do
cases that CPS is involved a good job and there are others who want nothing more to
in and I don’t know who to do than refer it to police and close their case.*
contact. Even on a case now § Their job is to protect vulnerable children when no one else
I learned information much will or can. It seems that over the past few years they have
later than I should have. faded away from the police department and they don’t
§ They close cases too quickly contact us until they get into a situation that they can’t
and do not monitor the control.
situation long enough. § CPS starts an investigation on the criminal case without
notifying the police dept. and then they tip off suspect and it
messes up the case.
§ CPS is a mandated reporter of crime but they are not diligent
about reporting.
Training/knowledge
§ CPS is supposed to protect the welfare of the child yet in too
many instances they have incompetent workers and they
lack training in child maltreatment *
§ CPS workers do not generally have the necessary interview
skills to investigate child abuse appropriately.*
§ You can only do what you are able to get to.
In Harm’s Way
Opinion of CPS
Community Service Providers Physicians & Medical Social Workers

CPS Focus CPS Focus
§ Their mission needs to be to protect children, too much emphasis is placed on reunification of § Their primary goal should be to protect and ensure the safety of
the family.* the child but they place too much emphasis on reunification.*
§ To protect children, it is in the name of Child Protective Services. That really should be their § Parents rights are considered above the rights of the child.*
job; it’s to provide a safe home, whether it is by reunifying the family, putting them into foster § CPS protects children in the context of the family and herein lies
care, or placement or adoption. the rub; family preservation has been the concept that all too often
§ Unfortunately, the current system is that parent’s rights are considered more than the safety of ends up with a child being a victim of a fatality.
the child and it causes lots of problems.* § The problem is they put the burden of proof on a child to survive
§ Parent’s rights always take precedence over children’s rights. We have a kid right now that the by putting them back with the family, it is always their first step.*
family had 14 CPS referrals before the child was ever removed or put into care or anything was § Often we see is after the case is closed, the family resumes as it
being done. No one is looking at the whole picture. did before. Cases need to be kept open longer to assess the
§ To investigate allegations of abuse and neglect and to protect children and then their next motivation of the family and the safety of the child.*
mandate is to reunify, if at all possible with the family and they have a special mandate specific § Cases are not monitored long enough and closed too quickly.*
to that. § CPS focus should be to be a child advocate.*
§ CPS only seems to focus on putting out fires. It is very reactive. § They are not able to assess child maltreatment accurately. They are
§ What I think they are and able to do and what people would like to see them do don’t often not competent to assess medical maltreatment issues.*
come together. § Parents don’t complete services, they give excuse after excuse and
§ To open and close the cases as quickly as possible.* nothing is done to look at the needs of the child.
§ I think CPS thinks their primary goal is to keep families intact if at all possible and child § CPS is getting a little better because they have been burned we
protection is secondary. have to take this momentum and run with it. Every one should
§ To keep families together and to ensure that children are safe, I think it is one in the same, work together and collaborate with each other.
don’t think we can have one without the other. § Each case should not be just rubber stamped for services and
reunification.*
Training/knowledge
§ When you hire someone who is not knowledgeable in child welfare and expect them to do this Administration/knowledge
kind of work it is a problem that could lead to a bad outcome. We see the results of this all the § CPS workers and their lack of knowledge surprise me. They don’t
time.* understand child abuse and injuries and lack basic medical
§ Some of the CPS workers out in other locations often do not have the training; they come in knowledge.*
with a different mindset and different goals. This is not a trial by fire; this is let’s find out § It’s not a 24/7 system. The system is disorganized, lack leadership
what’s going on and let’s help this family. and competency.
§ I think sometimes unfortunately, we get workers who don’t have training and support and are § I think we will cut some of the bureaucracy that currently exists.
overloaded and they come in here and it is automatic, let’s hurry and get this done and lets There is a definite problem with following the protocol.
move on and you better tell the mom she better protect that child or I am yanking the child. § Parents given too many chances.
§ CPS has been very frustrating to work with and I perceive that the
Workload/procedures workers for the most part are terrific. Their biggest problem isn’t
§ However, I see some problems in the CPS system. The turnover rate leads to instability with the families out there but that they don’t have supervisors who
the child and all parties involved. E.g. one child had four different case managers in 2.5 years. support them as they should.
It does not bode well for the child and it continues to raise suspicions in the child. They need § We have a problem in Arizona in this second triage level of
stability and trust. substantiation, where they have to go through another level and
§ I think that they are overwhelmed in their capacity to be able to protect and thus a great number our statistics for substantiation are a fraction of what they are for
of children slip through the cracks.* the rest of the country.
§ It is amazing to me that as we are a primary provider, we aren’t offered the opportunity to
discuss these cases and provide input. This needs to change and we should be a part of the Resources
decision making process regarding the kids who are in our care.* § The system lacks the resources it needs to do the job. The motto
§ I think our state’s laws and the processes that are put into place hinder them from doing that seems to be, “act only if the child is in imminent danger of death.”
job. Their incredible caseloads also prevent them from doing a job that they want to do. I know § We don’t have enough community involvement in a sense that
some good supervisors and caseworkers. There are some pretty lousy ones too. these children belong to all of us. Their well being should be
§ CPS has so many people to answer to, legislation and so on that they can’t do their primary job. important to all of us.
When we get a call alleging abuse we tell the caller to call the police and then the police can go § They need a better tracking system to locate the family. You can
out and make a report and maybe file charges instead of just leaving it up to CPS. track down some one who moves by other means, i.e. VIN etc.,
§ I think that some of the administration at the central office should go back into the field and but when families move and CPS can’t locate them, the case is
supervise these caseworkers. closed and often unsubstantiated. The medical information is lost.
§ I think they need to be able to interface with other CPS programs as far as an exchange of There should be a centralized system that tracks down all of the
information because people do get around. I also think that as much as possible they educate relevant information that is relevant to that child. Moving
the public in what they can do and what they can’t do. shouldn’t mean the case is unsubstantiated.*
§ I think it is their job to investigate when asked to do so, to do a good job of follow up, and to
do the very best they can for the children and the families they interact with as far as getting
services, and follow up is also critical.
§ I would like to see more options for these families where the kids shouldn’t be returned. The
case needs time for a worker to be able to actively investigate the case and monitor the case.
In Harm’s Way
TABLE 7
Case Plan
CPS Workers
How do you evaluate your case plan to prevent the recurrence of abuse?
§ We evaluate based on the primary goal of reunification, since that is goal of family centered practice. We assess and reassess every 6 months.*
§ We have services in place; the caseworker draws up the case plan and then they go over the case plan with the family. We conduct a safety assessment and determine what
the needs are for that family to reduce the stress factors in the home. *
§ We have a “best practice” model. We are looking at getting accredited.
§ We have a reassessment tool that workers can access from the computer. We use it as part of the decision making process and also take into consideration the reports from
the providers who are a part of our treatment team. We do our best job to assess and provide services and to assess the risks, but there is no guarantee it might not happen
again. We do our best.
§ You do a whole assessment of what’s been happening, you look at the family history and then you look at what your own experience is with certain cases and individuals.
You look at what is relevant to use on the case.
§ We put together a plan and try to make it specific for each family.
§ We review the plan and try to develop other options as needed, but our primary goal is to protect the children but remember, we are a family centered practice so
reunifying is always our primary goal.
Do you work on concurrent planning for reunification and placement when working on a case?
§ Yes, we work with families on the case plan and we monitor them to ensure they are following the plan and following through with services whatever they are. We work
hard at trying to empower the families to comply with the plan and we help the family to be able to help themselves so that they take responsibility.
§ Yes, if I don’t start seeing results or stability in parents, then it gives me the idea that I better look for plan two, which is always the concurrent plan. We have concurrent
case plans. If the first one doesn’t work out then we will go to the concurrent plan.
§ Yes, it’s mandatory, reunification, guardianship, and relative placement. Then we look at severance with adoption.
§ We always do concurrent case planning if the case plan of reunification fails.
§ Concurrent planning is not necessarily used when we are planning to reunify from long-term foster care.
§ Severance and adoption might be planned if reunification is not possible.
Do you conduct a background check and provide a thorough assessment on family members identified as temporary caregivers?
§ Yes we are required too. We do a home study, and request a criminal background check.*
§ In many cases we do a criminal background check.*
§ We have a process to get a background check, however, DES policy permits us to do a guardianship without a background check in place.*
§ With all family members in the household over the age of 18, we usually request a background check.
§ Yes we do. CPS requests a background check. We just had a battle with JPO because they don’t have to have background checks.
§ We may not get background check back for 2-3 months.
In Harm’s Way
TABLE 8
Reasonable Efforts
CPS Workers
What is the definition of reasonable efforts?

§ We do everything to provide every service possible to reunify the family. Case management, transportation, parents’ aides and etc. The court determines, whether we have
made reasonable efforts or not. *
§ I don’t know -- you have explored every single opinion before taking a kid.*
§ Identifying a concern and being willing to follow up on a case.
§ The standards or goals set up by the CPS worker in the case plan and if they take it seriously then the family will take it seriously too.
§ We focus on, “did we make efforts to prevent the removal of the child from the home or progress towards reunifying the child back with his or her family?”
§ It is the efforts set forth in identifying the case plan to include the goals and objectives that are defined.
§ The court determines “reasonable efforts”.
§ At intake, it means doing everything possible to ensure the child’s safety.
§ In ongoing, it means active steps toward reunification and/or a permanency plan.
§ The caseworker and parents have tasks set out for them listed in the case plan (reviewed every 6 months).
§ Reasonable efforts mean we have done everything we can and provided necessary services.
§ Case plans state the expectations and how the agency is collaborating with the family to remedy the risk factors.
Do the caseworker and parent understand “reasonable efforts”?

§ I think reasonable efforts are rarely spelled out clearly for the family either by CPS or the courts.*
§ Yes.*
§ I would question whether or not they would be understood by the parent. In some cases and I am sure you would find caseworkers that don’t really grasp the concept of
needing to make reasonable efforts. In general most workers know what they need to do to meet reasonable efforts.
§ Most cases managers understand them. Often times they are not understood by the families we are dealing with.
§ Not really.
Are “reasonable efforts” defined in the case plan?

§ Yes.*
§ Yes they are but not sure if they adhere to it.
§ Yes, it has all the tasks that need to happen written out in order for the child to be able to go home and we have a time frame to adhere to.
Under what conditions a child should be reunited with a caregiver before a police criminal investigation is completed?
§ I rely on the commitment of the police officer. If the officer thinks children should be removed then I will present it.
§ When there are allegations of sex abuse; if offender is removed and mom is willing to protect the child.
§ If the child is placed with a responsible parent.
§ This is probably pretty case specific and depending on the circumstances. If there are pending criminal charges for child abuse, neglect and if the offending parent doesn’t
have access to the child and the caregiver is willing to protect the child from the offending parent.
§ In the on going unit, we look at how the case is progressing and many factors are taken into consideration before reunification. It depends on the criminal act that was
committed. We would have to look at how the parents are participating in services, how the case is moving along, how visitation is going, and what the opinion is of the
treatment team.
§ When services are in place and the parents are willing to protect the child. When they have completed services and the risk factors are reduced.
§ I would say in that situation, I don’t think we would ever reunite the kids with their parents if there were some kind of criminal investigation going on. We would probably
wait until that was done first.
§ It depends on the allegations and the severity of the injuries. If a child is in imminent harm, they are not returned.
§ If the child is at risk and we are able to determine that the child will be safe. It is based on the history of the parent’s ability to protect the child.
§ When the risk for abuse no longer exists.
§ When the perpetrator is removed.
§ When the parent becomes motivated and truly begins to care for the child.
§ I would reunite with a caregiver when I see that conditions have improved.
In Harm’s Way
TABLE 9
Examples of Dissatisfaction with CPS or Where a Case Resulted in a Bad Outcome
Police, Physicians & Medical Social Workers
Prior reports
§ A neglect case, where a 10 year old called the PD and the mom was smoking PCP and she was under the influence with her kids at home, and CPS had 5 prior referrals.
We found past reports of the mom using drugs and each report was referred to family builders, and again the outcome was always the same.
§ Another case goes back thirty years and CPS was involved in it numerous times and they placed those girls back in the house with him and he continued to molest them.
We just went to trial last week and he was found to be guilty and now is in prison. This case had multiple referrals to CPS for abuse.
§ A 10 year old called the police because his mom was smoking PCP with the kids in the home. Her 3 year old was found standing in the street alone. They had 5 prior
reports to CPS, each one referred to Family Builders.
§ Most of these cases that we see are really bad, when you look back there are so many priors on these families; so may of these cases are unsubstantiated, unsubstantiated,
unsubstantiated, and you have to wonder what is going on out there.
Victim recants/won’t cooperate
§ These little girls were saying that their step dad was molesting them. We arrested him and the girls recanted because he was the breadwinner of the family. Mom put a lot
of pressure on them.
§ The offender’s boss called the mother and told her that she better get the offender out of jail. The children recanted the abuse.
§ A little boy, had breaks in his foot, his testicles were bruised, his penis was bruised, and he wouldn’t disclose who did it. He had multiple caretakers who had denied
abusing him. One caretaker had medical issues and was unable to take a polygraph examination. Mom took polygraph and failed. CPS placed him with his grandma in NV
and closed the case. Mom left and went to Nevada. I don’t see how that was real closure.
§ I have a case where two young brothers reported that mom’s boyfriend was molesting them and we put the case together, arrested him and he denied it. When it got to the
county attorneys office, the mother had been visiting the suspect. All of a sudden she calls me and says my two boys want to talk to you, they made the whole thing up.
So, I put the boys alone in a room and recorded it, and the one boy says to the other one, “I told the truth, I said what the boyfriend did to us” and the other boy says,
“don’t tell them, you know what mom told us.” I had a problem with mom not protecting the boys and the county attorney’s office made the decision not to prosecute
because the boys recanted, even after I showed them the video of the boys conversation, they dumped the case.
§ On many occasions, CPS has interviewed a child in front of the suspected perpetrator and then closed and unsubstantiated the case and didn’t tell us about it.
Plea agreements/sentence
§ The plea agreements they offer are bogus. When a person is facing more than one count, even up to17 counts and they dismissed them, it is just wrong. When they plea
down to a lesser crime, there isn’t any rehabilitation for these people and they are going to re-offend.
§ A plea where the suspect gets a lengthy prison term can be helpful to the child to avoid having to go through a hearing. The other situation that is a real problem is a
suspect being offered a minimum sentence that is way too low for the crime committed.
§ Judges let defense attorneys get away with too much. A lot of people say if they knew going into it what they knew after it was over, they would have never reported it.
§ Not specific cases, but there are cases where the county attorney had a confession, the victim disclosed and the suspect was offered a plea. There should be less plea
agreements for these kinds of crimes and better prosecution of these cases.
Lack of evidence
§ The suspect fled and the investigation was delayed for 4 years, the case was not filed because of a lack of corroboration.
§ Other cases where CPS went out first and interviewed the suspect; they tip the suspect off before the police can interview the suspect and they know they are not qualified
to interview, it damages the investigation.
§ In cases of child abuse where there is a lack of evidence, the case can’t be treated as a criminal investigation and the child is left in the same environment. In many of these
cases the parent is the perpetrator. If the case can’t be substantiated, the parent can tell the worker to pound sand.
§ Sometimes, we don't get enough information or have enough evidence. In cases like that, when we know something has happened but don't have evidence to support the
allegation of abuse, it’s hard.
§ I have seen many CPS workers who lack basic interviewing skills and this can cause a lot of problems in managing these cases.
Prosecution
§ A mom was high on drugs and was in an auto accident. The child died and it was her fault. Its four years later and we are still waiting to go to trial. Sometimes, I see a
lack of effort put into prosecuting these cases.
§ A child was chronically neglected and died. We can’t get the case prosecuted.
§ There was a case involving a 17 years old mentally ill teen and was being molested by an unregistered 60 year old pedophile. He wasn’t a good victim and it was never
prosecuted.
§ A child abuse case, where a guy gave his 16 year old daughter a “good old fashioned ass whooping,” and in this beating, he broke her thumb and left bruises all over her
body and it got turned down. This is a good example of, where the prosecuting attorneys that we deal with, (who advise us on our cases), said the case should have been
filed and the charging attorney decided to turn it down.
In Harm’s Way
Examples of Dissatisfaction with CPS or Where a Case Resulted in a Bad Outcome
Police, Physicians & Medical Social Workers

Family should not be reunified
§ There is a case right now where the girl was initially removed; the dad was sniffing her crotch. The girl was put back in the home with her mom and then her dad was
released with a monitoring device. Prosecution filed the case in court. Mom wanted to send girl to Philippines. The prosecutor asked for a GAL to be assigned. The Judge
refused to assign a GAL, which put the girl in a bad situation. CPS should have kept child with Aunt.
§ There was a burn case and the children were taken out of the home and a legislator got involved and contacted CPS and it filtered down and children had to go back home.
The legislator was a friend to the family. She pressured CPS, the CA’s office and contacted our Sergeants. She announced that she was on a committee who had CPS
oversight and was going to see to it, that the law gets changed.
§ Mom was a methamphetamine user; a child was removed but then returned even though mom did not comply with the case plan or treatment.
§ A horrible drug case where narcotics saw a dad punch his kid in the chest and the kid flew across the room. The child resided in a filthy home. There were needles and
drugs in the home. Both mom and dad were put in jail. CPS ended up placing the child in North Dakota. CPS keeps calling wanting to know when the parents are getting
out of jail in order to reunify the 8 yr old boy. Both mom and dad are addicts. CPS put the child with his grandmother because the parents agreed to family group
decision-making. CPS’ agenda on this case is to constantly call to find out when they can reunify.
§ A specific case in the Behavioral Health Unit where the staff stated their position on the case that CPS wanted to reunite the child with his mother. The social worker
pleaded with CPS not to return the child to his mother and his pleadings went ignored. They placed the child with his mother anyway. A couple days after the child was
reunited with his mother, she killed him.
§ In many cases, newborns exposed to in-utero drug abuse are sent home with the parent with CPS stating “It’s a lifestyle choice”. These children would go home with these
families and we would have to prove they were neglected and prove they were abused before CPS would intervene and take them out of the homes.
§ A child was sent back to Florida to a mom who abused the child. The plan was return to parent even despite hospital staff objecting to the local CPS and to Florida CPS.
We objected strenuously to that plan and presented our treatment plan and our recommendations for this child. It wasn’t a good situation.
Policy problems
§ Another issue is police agencies can’t authorize medical exams on cases of physical abuse. It has to be approved by CPS. If we have a physical abuse case that doesn’t fall
under CPS jurisdiction, we can’t get medical authorization for the person to be seen by a forensic physician and we can’t get an examination done on that child.
§ The only problem I have is that CPS has a time line, we do not. They can warn the perpetrator of the allegation before we have a chance to finish the investigation.
§ When protocol is not followed. When there is an in home molest and the call goes out to patrol and the sergeant is limited, and I don’t get the case until the next day. I
would go out to the house and the kid would be somewhere else, the perpetrator is already aware of the disclosure and then I will am not as successful in working the case,
due to the time delay.
CPS does not act
§ There are a lot of times where you have a child molester molesting a neighbor child and we contact CPS to inform them of the situation and the molester has his own
children living with him and CPS won’t get involved because there is no report known to them on his child, even though he is a known child molester and is most likely
molesting his own kids. CPS won’t get involved or take a referral for that.
§ There was a case where a special education child was in the home and wasn’t in school for three and a half months and no one made a home visit.
§ We have a case where CPS should have removed a child a year ago but failed to. Mother was in drug rehab for a short time and she stopped going. CPS kept trying to
reunify the mother and child and it caused a huge delay in the system. During that process, the child did not receive the kind of care he needed.
§ There was a case where the CPS worker was not competent to make a judgment call. This worker “eyeballed” the baby and concluded the baby was fine. The baby was
not fine and needed immediate medical assistance. This baby was severely neglected. Case worker training is poor and the skill level of the worker must be improved. A
medical report needs a medical assessment; not a visual inspection by a CPS worker.
§ Another case involved a 15 year old girl who disclosed that she woke up and found her step father in her bed with her pants pulled down and he was touching her vagina.
She asked, “What are you doing?” He got up and left her room. She went to school and disclosed the incident and stated that this had happened to her more than once.
CPS was called and the worker went out to the house after she got the referral from the school counselor. The CPS worker sat down with the victim, the mother and the
suspect in the living room and interviewed all three of them at the same time. They ended up closing their case and sent them a letter stating that the allegations were
unfounded. This happened in May 2002. I call the mother the other day and she was absolutely dumbfounded and stated, “I don’t know what to believe.” As I talked to
her, she read the letter from CPS stating the case was unfounded. I don’t understand how they can close a case and unsubstantiated it when they don’t have the facts, other
than a conversation with all three family members at the same time. They just basically sat and talked to the people. So, I got a hold of the suspect on the phone and he
corroborated everything the girl had said that happened to her. With the suspect is still in the home, I got the girl on the phone and she reconfirmed that the abuse
happened. Needless to say, I got the suspect back on the phone and he admitted to committing that same act more than once.
§ I have a case where a child was mentally challenged and severely neglected. This child attended North High School. She would come to school with bruises on her body.
CPS was called in and had an open case on her. The school had to help to keep her clean because she often came to school very dirty. The county attorney turned the case
down because being dirty doesn’t necessarily mean the child had health problems. There were notes of physical abuse (bruising) the child had no glasses. On Friday, the
school nurse put a maxi pad on her and on Monday, she returned to school wearing the same pad. CPS will not remove this child from the home.
§ Recently, we had a case where CPS should have removed the child a year ago, but failed to. The mother was in a drug rehab for a short time and stopped going. CPS kept
trying to reunify the mother with the kid. It caused a huge delay in the system and the child did not receive the kind of care he needed. Medical personnel should
automatically be able to go to hearings and not have to wait for an invitation from CPS.
§ There was a case in the behavioral health unit where the staff stated their position on a case that CPS wanted to reunite the child with his mother. The social worker
pleaded with CPS not to return the child to his mother and his pleadings went ignored and they placed the child with the parent anyway and he was killed a couple days
later after returning home, by his mother.
§ The bureaucracy creates so many forms and paper work; paired with a lack of knowledge, often the worker is not competent to make a decision based on the child’s
situation. For instance, in the case of baby S, the worker was not competent to make a judgment call. This worker eye balled baby S and concluded the baby was fine. The
baby was not fine and needed immediate medical assistance. This baby was severely neglected. We almost had a dead child. A medical report must be assessed by an
appropriate medical professional, either a nurse or a physician. A child off of the growth chart is not okay. A worker should not be given the discretion to make medical
judgment calls. A trained medical professional should be the one assessing these cases. Siblings should also be looked at when assessing a child who has been abused by a
caregiver. Research shows that when one child is abused in the home, the siblings are also victims of abuse. Siblings should also undergo a medical evaluation.
In Harm’s Way
TABLE 10
Child Abuse and Neglect Risk Factors
CPS Workers Community Service Providers Physicians & Medical Social Workers
§ Substance abuse, drugs/meth/alcohol * § Substance abuse * § Substance abuse *

§ Abusive relationships/codependency * § Financial instability/poverty * § Domestic Violence *
§ Poverty/homelessness * § Lack of education/job skills * § Lack of community support and services/isolation *
§ History of abuse or neglect * § They have no support systems, this is a transient § Poverty/unemployment *
§ Mental illness * state/isolation * § Mental Illness *
§ Parents who refuse to deal with their § Stress/fast pace society/society/environment * § Poor education *
issues * § Domestic Violence * § Single parents *
§ Repeat substance abuse pregnancies * § History of abuse * § Lack of CPS intervention regarding children’s education
§ Parent’s’ rights supercede children’s § Teen parents/maturity * and attendance in school
rights * § Parents being ill equipped to parent children * § CPS quick to close cases
§ Environmental § Mental illness * § High turnover rate in CPS, with workers having little or no
§ Not enough rehab resources § The system is lacking in adequate services to fill the feedback from supervisors.
§ Mothers self-medicating, needing need/lack of community support * § Medical workers are prohibited from attending hearings,
mental health services § Lack of healthcare benefits * therefore at times; a medical report is without medical
§ Lack of coping skills, § Ignorance of child development * assessment.
§ Lack of parenting skills § Not enough resources for drug and alcohol rehab * § Stepparents
§ Inadequate, unsafe, and unmonitored § Lack of clear social norms on what good parenting § Lack of parenting skills, history of child abuse of parent
group and foster homes that may is/role models * (multi-generational) abuse, access to care and resources,
subject kids to further abuse. § Single parents * continuity of medical care.
§ Lack of support § Low impulse control * § More efforts need to be placed on prevention.
§ Disproportionately high minority population. *
§ A lot of families who have issues with seeking help
because they see it as a failure and there are also
families that just always depend on the system for
being taken care of. *
§ Unrealistic expectations of children
§ There are a lack of prevention programs
§ Strangers living in home

§ Multiple boyfriends in and out of home
§ Patriarchy. Whenever there is a system where
someone has power over someone else, there will be
abuse, whether it is men over women, parents over
children, whenever there is an imbalance of power
there will be abuse.
§ It comes to family values, children being left alone.
§ Parents working two jobs
§ Hopelessness, not knowing resources available.
§ Children with special needs, aggressive personalities,
lack of early age bonding, unprepared caregivers.
§ Lack of coping skills, how many children people have
and whether they have a supportive environment.
In Harm’s Way
TABLE 11
Risk Factors That Lead To Repeat Maltreatment
CPS Workers Community Service Providers Physicians & Medical Social Workers
§ When an unsubstantiated report should be § Continued substance abuse, domestic violence. * § Continued substance abuse *
substantiated. If anyone in field is not § Parents who lack education and support to correct the problem. * § Domestic violence, financial stress
substantiating a case that should be § A child welfare system with no accountability or checks and balances and mental illness.
substantiated. when decisions are made that are not in a child’s best interest. * § Cases not monitored and/or assessed
§ When parents put the child at risk by not § Mental health problems. * as they should be.
following through on the case plan and when § The failure of the system to deal with it the first time. If you don’t deal § Lack of medical examination
they don’t follow through on what is with it the first time, it is going to be repeated. * requirements for children referred to
suggested to them on the first referral or § The child was not removed from the dangerous situation.* CPS.
when they don’t take our advice. § Inefficient help provided to the abuser. § Lack of community support and
§ The parent being a past victim of abuse. resources.
Risk factors and child stays in home §
§ Multiple times a child is removed and returned to the offending parent. We have a large percentage of
§ Our hands are tied by law, if we have no unsubstantiated cases.
The child is in and out of the system. With each incident there is more
proof, then they have to understand there is § Fixing only the symptom, not the
damage to the child.
not a lot we can do. Sometimes we will
receive a report regarding allegations of § Bouncing children in and out of multiple foster homes; causing real problem
emotional damage. § Most of these cases that we see are
sexual abuse but there is not enough
evidence to remove the child. * § Lack of treatment. really bad, when you look back
§ Parents cannot change their lifestyle choices and maintain a troubled there are so many priors on these
§ Parents who refuse to comply with services families and so may of these cases
or do not follow through with substance pattern.
§ Kids are getting sent home too soon when services haven’t been are unsubstantiated. You have to
abuse treatment are allowed to parent wonder what is going on out there.
without any monitoring. * provided to the family.
§ § CPS needs to look at old referrals to
§ Financial resources go to support the parent’s Often the foster parents are not supported and they don’t have what
and not just treat the referral as a
drug habit instead of caring for their they need to adequately and effectively provide for the child. They
don’t receive the support they need. We end up loosing good foster new one when an old one was
children. The child’s needs are secondary to unsubstantiated. They need to set a
their drug dependence. * parents.
threshold and when another referral
§ If a child keeps running back to the home; § The court systems failure to protect children.
comes in, this is a family to know
sometimes the judge will allow the child to § There is a lack of successful intervention programs. Many of the and there should be triggers.
stay at home even when there are still risks. programs don’t work. Substance abuse should be an
§ Shaken babies are sometimes left in the § Some of the parents with criminal histories will be put in halfway automatic trigger.
home even after the baby has been medically houses. I am not sure how effective the programs are once they are in
checked out. the system.
§ We are going to start to do in home petitions § I believe there has got to be something more out there to help these
where we allow the child to stay in the home parents and to have something that works. CPS states that drug use is a
as long as the caregiver is complying with lifestyle choice but it is more than a life style choice, it is generational.
services. § The programs need an element of how to integrate child safety in the
§ The child may be at very high risk and we home. There are anger management classes available but those
will put in services in depending on the programs are all disjointed. They are not taking the information they
circumstances in order to preserve the are getting from these classes and applying it themselves.
family. § The only programs that are successful are the one’s that the user seeks
§ In cases of sex abuse, if the mom is not out.
willing to protect or believe the child then it § Primarily due to a lot of the risk factors are not addressed. This leads
would place a great risk on the child who is to a lack of intervention.
in the home. When a home has no running § Not seeking the support that is available, repeating patterns in the
water or when a parent is not willing to care family for generations, repeating the cycle of the system.
for a child’s medical needs. § People have no impulse control. They don’t have coaching on how to
develop appropriate skills. They have difficult children/handicapped,
and so on.
§ Medical exams on children referred to CPS should be required. CPS
needs to improve the goals of the case plan and decisions made in the
case by including the concerns outlined by the professionals who are
also involved in these cases.
§ CPS makes too many judgment calls and without the training, the
judgment calls are troubling to other professionals. They do not have
the medical knowledge to make judgment calls on neglect cases or
cases requiring medical assessments.
In Harm’s Way
TABLE 12
Relationship of Adult Substance Abuse to Child Abuse
Judges Prosecutors Police CPS Workers
§ We frequently see co- § Approximately 80 percent § It is a real problem. It is in the majority of cases seen. § In our system, a majority of cases
occurrence of claim substance abuse as a * have drug use as a factor *
substance abuse, child concurrent problem. * § It goes hand in hand. The parent’s cannot relate to § It affects parenting skills *
abuse and neglect. § Most child abuse cases problems in their household. They are not concerned § It is their way of self medicating and
§ It is an indicator of include substance abuse. with the children but with were next fix will come not being able to meet the child’s
mental health, stress, § Drug use, itself causes from. * emotional needs, if you can’t meet
and financial hardship. damage to children. § You also see the cycle of abuse repeating itself. * your own. *
§ There is usually direct § Drug abuse initiates abusive § Male adults who use let their inhibitions down and § Parents are in denial that they have a
correlation. behavior. sex abuse occurs more often as well as physical substance abuse problem. *
§ Which comes first in these abuse. * § Substance abusers often have mental
cases? Is it drug abuse or § With women who use, you often see physical abuse health issues. *
child abuse? and more often neglect, because the kids are getting § It creates anger.
in their way of their drug use. They are using all of § Drug abuse can affect employment
their money on drugs and spending most of their time and housing.
using. * § Treatment should be mandated in
§ There are also a lot of drug exposed babies. In homes certain situations, now it is only
children are exposed to drugs when there is drug volitional.
paraphernalia lying around including needles. * § When a parent coming down off of
§ It is a significant issue. Alcohol decreases inhibitions meth, it can be the most dangerous
in adults and it increases their inability to stop abuse time for that child.
cycle. § A parents’ frustration level becomes
§ As far as charging child abuse, it is vague for the higher and in general, a parent who is
county attorney in what they want law enforcement a user may have underlying issues,
to do. You have to show that the adult intended to which are not being dealt with.
hurt the child in order for the person to be charged. § But, it is up to the parents to seek help.
§ There is an increased risk of physical abuse and
molestations from strangers in the home using the
drugs.
§ Addiction puts children at risk for physical and sexual
abuse as well as neglect.
§ Substance abuse leads to poor judgment
§ An increase in violent behavior is associated with
drug use.
In Harm’s Way
Relationship of Adult Substance Abuse to Child Abuse
Foster Parents Community Service Providers Physicians & Medical Social Workers Guardians Ad Litem
§ A Significant § Substance abuse is the major contributing § The lifestyle of the people who use drugs, § Substance abuse is almost always
correlation. cause of child abuse. * either they don’t get medical care or a component and it results in the
§ Most cases involve § The focus is on substance abuse, not the unorganized to seek medical care. They parent putting their own needs
drug abuse. children * don’t get proper nutrition because the before their children’s needs.
§ It keeps children § It alters the mindset of a parent, who then parents are into drugs. * § It is a primary issue. I think that
from returning lacks judgment and patience. * § There is an increased risk for sexual abuse 99 out of 100 cases of abuse
home. § It is huge and about 90% of kids have because the children are exposed to strangers revolve around substance abuse.
§ It increases the witnessed or have been a part of drug use in who they often are doing drugs with or they § It’s critical; they can’t provide for
chance of abuse. the home. * leave them with strangers while they leave the child emotionally, kids will
§ Good parents § Children are put in risky situations because of the home to use. * turn to drugs to cope.
change and substance abuse. * § In utero drug abuse is an issue. These babies § It leads to personality changes.
children suffer § About 75% of child abuse is related to shouldn’t have to go home and prove they Parents become more aggressive
both mentally and substance abuse. are safe in the home. * and it leads to a life style of
physically. § I estimate that 60% of kids in the juvenile § Children exposed to drugs, therefore creating crime.
§ It causes a parent justice system have parents with substance future pattern. * § Parents become irresponsible
to neglect his or abuse problems. § Parent lacks control of their life and the lives under the influence.
her children. § It causes instability in the home. of their children. § Parents are more likely to abuse
§ It destroys the § There are not enough effective rehab services § Prenatal care poor due to mother more and neglect children while under
family unit. available. interested in drug the influence of drugs.
§ The parent thinks § Parents spend more money on drugs than they § Probably an 80% correlation. Additional risks occur when
only of the drug do on necessities. § CPS has considered drug use, “A life style parents leave drugs out and they
and/or how to get § Not only do these kids watch it in the home, choice”, “you can’t take these kids away become accessible to the
them instead of they have been exposed to it at an early age. It from families that are using drugs.” I have children.
the needs of their becomes part of their culture. been frustrated with this. The children would § Of course, when you are on
children. § We are only putting a band aid over it and go home with these families and we would drugs you can’t parent.
getting a parent to treatment is only a part of have to prove they were neglected and prove § CPS considers drugs & alcohol
the problem. You also have to look at what they were abused before CPS would abuse a life style choice. When
caused them to cope like that. They are intervene and take them out of the homes. parents use, the children are in
modeling poor coping skills for the child who § Kids in these types of homes are at high risk danger, domestic violence is
may very well learn the same coping skills and for abuse; both physical and sexual, and for ramped and there are not enough
repeat the substance abuse behavior. neglect. immediate shelters to provide
§ It depends on the individual. In cases of meth, safety from abusive situations.
it could make someone violent, in cases of § Yes and CPS takes the position
marijuana; it could cause complacency and a that drugs are a life style choice.
lack of attention. Alcohol, as a legal drug is § We need court orders in place to
also a problem. monitor sobriety. These orders
§ It is high risk factor for maltreatment. are necessary.
§ Substance abuse does not cause the abuse, but
the addiction becomes the whole focus of the
parents; more important than the child’s needs.
§ I think some situations are recognizable. I’m
also thinking it’s the unborn child who has
suffered the most.
§ Significantly, and it is a real problem. It is an
ongoing problem, these kids are in homes
exposed to drugs, having access to drugs and
often they are being abused or neglected by
the parent who is abusing drugs or by
strangers using drugs with that parent. A child,
who continues to be left in the care of multiple
strangers, is at risk.
§ It is more than just a life style as CPS explains
it. Parents who are using drugs cannot
effectively parent their children. Court ordered
treatment doesn’t always happen and the
resources for court ordered treatment are slim.
§ The kid is in a family system where the
caregiver has never received treatment
because it wasn’t offered or pursued. Worst
yet, services were not even available to them
due to long waiting lists. Or, there was no
pressure to go into treatment because it was
considered a life style choice.
In Harm’s Way
TABLE 13
Current Caseloads
Judges Police CPS Workers Guardians Ad

Litem
§ It is difficult to Average caseload: Average caseload: § I have100 –
detect but child § We average 20 to 30 cases per month. * § Our average caseload is about 12-20 children per worker. * 120 to 180
abuse and neglect § If it reaches 30, I definitely feel behind in my § Our current caseload is very high right now. *
cases.
remain as case responsibilities. § I have100
§ We get a lot of repeaters.
pervasive social § I know some detectives who are getting cases.
§ It was not unusual for an investigative worker to receive 4 to 5
problems. hammered; they are way out there with a § I have from
§ Cases are certainly reports per week, to work on and sometimes it was even more,
caseload of 60 to 80. 60 – 90
rarely was it less.
more time § At the first of the year out of 1658 cases, there cases.
§ For an ongoing caseworker, we now count cases by the
consuming in were 20 crimes against children cases. § I have 30
children and not the families. In the past you could have had 17
family court since § I am carrying about 52 cases. families and forty-five children. Now you are looking at, for an
cases.
an additional § I average about 3 to 5 cases of child abuse a experienced worker, to have about 22 to 24 children. § I have 25
investigation and month. cases each
evaluation is § The new worker plan for ongoing workers after they complete
§ I am carrying approximately 100 cases. their three month training is: from week one to week four, they
year.
required.
§ I don’t know. can have 6 to 7 children, from week four through month 3, they
§ Each Family Court
§ A typical child abuse case load? I don’t know build up to 8 to 12 children, from month 2 to month 4, they
Judge has
and I don’t want to know, it will just depress me. have up to 13 to 17 children and from month 3 to month 6, they
approximately
1000 divorce § About 150-160 cases open, per detective. We have 18 to 20 children and then the last bit over laps, from
cases. I am not get assigned 60 or 70 cases. Approximately, month 4 thru month 6, they can have 20 plus children.
sure of the 90% are child abuse. § Approximately, 3 to 5 cases a week. At the hotline there are no
statistics of abuse § I have anywhere from 20 to 50 cases. caseloads, they take reports as the calls come in. Investigations
within these cases. § I average 20 to 40 cases. get about 3 to 5 per week and in ongoing, they can carry as
§ Can be more time- § Out of 120 cases per month, 60% are child many as 35 kids.
consuming abuse. I get 8 to 10 per week. § They count it by children in the current caseload. We have19
although the same § We did about 6000 cases last year and it ongoing cases, I have 35 to 40 cases in my caseload. There are
procedures apply. averages to be 225 cases per detective per year. only three ongoing workers. They don’t cover the area; there
§ Most cases involve That doesn’t count originals or cases that you are just not enough caseworkers.
spousal abuse, not assist on. The caseload can be overwhelming. § We get four new referrals once a week; it’s different in
child abuse. § When you add in the pended cases, it averages investigations. In investigations, it is like sixteen new referrals a
§ There are more to about 90 open cases. month.
emotional abuse § In neighborhood of 225 cases a year. § It is arbitrary from worker to worker; judge to judge, and there
cases. § At this time I have about 45 open cases. is not a lot of clarity and consistency for when children should
§ I get about 30 cases each month and try to keep be reunited with parents.
cases to approx. 20 something. We have asked § Our job is to return the children to their parents.
for help over and over again and could use the § I have about 17-21 cases.
manpower to be able to work these cases more § I carry up to 23 cases.
effectively and efficiently. § I have up to 30 cases.
§ I have about 38 open cases.
§ I try to keep it fewer than 30 cases. % of cases where the worker is able to make a home visit on time
§ The typical child abuse caseload is § More so now than in the past, we have a pretty good compliance
overwhelming. Detectives can carry 70 to 100 rate as far as that goes.
cases. § It is about 98%. By policy, they are to see every child in the
§ Right now I am carrying four cases of home every month.
maltreatment. § It is a hundred percent.
§ Spanish speaking detectives are buried. § Pretty much all the time, which means not working 8-9 hour
§ Child abuse cases are more time consuming days but some weekends.
and certainly different than other types of crime. § It is probably 95%.
Cases closed on average: § Our most recent caseworker survey states we have never missed
a visit. When there are extreme circumstances, co-workers
§ I close, on average, 3-5 cases per month * have helped out by making the home visits on time.
§ Each month, I close 1 to 2 cases. *
§ My average is about 4 to 5 cases. On average how many times does a case worker change?
§ Approximately 5 to 7 cases. § It is 2 to 3 times or more, the family may move or a worker left
§ About 2 to 3 cases per month on average. the agency. *
§ About 8 cases per month are closed depending § They change around six months to a year.
on the case load. § I know of some kids who have had 6, 7, and 8, case managers.
§ I close about 5 to 10 cases each month if I am The turn over and burn out rate is tremendous. It is not good for
lucky. the kids.
§ About 15-20 cases are new per month. I have § At least three changes are made during an open case;
100 open cases. investigative, ongoing, adoptions.
§ We have a high turnover rate due to low pay and high caseloads.
§ Because of the turnover, many cases have had as many as four
or more workers.
§ The turnover rate is 22-25% and this is due to the demands of
the job and the low pay.
In Harm’s Way
TABLE 14
Child Abuse Protocol
Police CPS Workers Guardians Ad Litem
Follow protocol Follow protocol § No, I just use common

§ Yes, we follow the Maricopa County protocol * § We follow Maricopa County protocol and cross refer to sense *
§ Yes, try to do our best to follow Maricopa Co. protocol, however, when police departments. § Not really, it depends
things happen fast there is not time to notify other agencies. § In general, yes we follow the Maricopa Co. protocol on the situation and
§ For the most part the protocol is followed. When we get a case we follow and every exception that is made, is made with the what the safety issues
it. approval of the supervisor. There may be some good are. I interview the
§ CPS for the most part at Childhelp follows the protocol. reasons why a policy or procedure might not be child privately and
§ I think the majority of the older patrol officers do a pretty good job. followed, but the worker isn’t the one who makes that then discuss the
decision. problems with CPS.
Do not follow protocol § Yes, there are some gray areas and a new revision is § It varies and it is on a
§ When we do not meet protocol and an investigation has begun without us, being done. case by case basis.
the element of surprise is lost. * § Yes, I work for the state. I follow the protocol because § I assess a case by
§ Not necessarily, because we follow the Pinal county protocol but they every time I ask my supervisor a question she tells me observing the child’s
don’t have a formal protocol for how to handle crimes against children. to look it up in the policy. environment, obtaining
§ It is important that you follow protocol. Some patrol officers do not § Yes, with Pinal County, our district is a busy office. We information from their
follow it, nor do their supervisors. are pretty particular in how we do things. caregiver, and
§ It is not always followed by patrol or by the schools and the victim determining how to
doesn't always cooperate. It is hard to follow it when the victim refuses to Don’t know protocol meet the child’s
do what they are supposed to do. CPS will go out and interview a person § I do not know all the policies that I am expected to medical needs.
before a detective can take the lead in the investigation, so they are not follow. § I always check the
following protocol. § I don’t know what the county protocol is. If you are placement to be sure
§ We see more of the problem of not following the protocol in the outlying talking about the that there is adequate
areas. Interagency Policy that we work together with the food, shelter and look
police, then yes. for safety measures. I
§ I am hoping the sergeants will be able to discern between calls that patrol
determine if caregiver
can handle and calls that detectives need to go out on. It has been a real
Other policies and procedures is appropriate.
problem when the patrol officers are not consistent in following it. Some
§ When I see a violation in a group home, I report it to
officers are new and they haven’t been able to learn the protocol or our group home investigations and they determine
integrate it into their daily work. whether the police are contacted.
§ No, the protocol is not followed. Last year we were told, no more over § Families can be referred to Families First if they need
time, no matter what. If we received a call at 3 pm and the last officer in only support and services.
office went home, then the report is given to the patrol officer. This § Our protocol for children and adults with severe
officer then becomes responsible to find a safe place for the child. When substance addictions is counterproductive, with the
patrol takes the lead initially, it may take the detective more time and courts doing little to help us help these families.
work to gather evidence. Some evidence may get lost. § We have a policy manual that we follow to a T.
§ No, we do not follow protocol, but are getting better.
§ We try to follow protocol, but because of a budget crisis, we weren’t When substance abuse is a factor in the home, how does CPS
being called out on cases. Instead, the cases were going to patrol. treat the referral?
§ I would say that the protocol isn’t always being followed. Most often we
have a break down in the protocol not being followed. This happens § We refer them to a drug treatment program. We make a
when patrol gets a call to go out and we are not notified. This also substance abuse referral. From there, we basically keep
happens when there is a breakdown of communication between patrol in touch with the counselors and therapists for a report
and the supervisor or between the supervisor and our unit. I think that we on how they are participating in their counseling. We
need more frequent training on the protocol and the following the focus on getting them into treatment. Our job is to
protocol needs to be enforced. basically make the referrals. *
§ We are supposed to work as a team with CPS but it does not always § We used to have in-utero substance abuse reports go to
happen. family builders for follow up and substance abuse was
§ There are times when we believe a child should be removed from a home taken as a lower priority case. That program was cut
but CPS does not. due to budget cuts and now the cases are going to CPS.
We have units that will be specialized in handling
§ Patrol officers have a high turnover rate and some may not know the child
substance exposed newborn cases now.
abuse protocol. We need to offer ongoing training to new officers.
§ Since the media publicized an infant death, substance
Who decides if case is submitted to prosecutor? exposed infants are now a Priority 1. They used to be a
lower priority case.
§ The detective decides when a case is submitted to the prosecutor. *
§ We have 2 units investigating substance-exposed
§ The detective submits the report and some times a higher up will
newborns. When substance abuse is a factor we do a
determine if the case should be submitted. Some of the minor child
safety assessment and develop a safety plan. We are
abuse cases are submitted for liability reasons.
filing more petitions in these cases.
§ The case agent decides when a case is submitted to the prosecutor. They
§ We cannot get residential treatment for adjudicated
are all reviewed by the sergeant and if it is a high profile case, then there
youth with substance addictions, the courts and juvenile
are more people interested in it. The case often goes to the county
systems do not help these kids either.
attorney’s office and they make the decision to file or not to file it and we
are at their mercy regarding if they are going to take it or not.
In Harm’s Way
TABLE 15
Should There Be a Referral to Law Enforcement for Every CPS Case?
Prosecutors Police
§ Some of the cases that law enforcement sends that do No, an army of officers would be needed. *
not fit the statute for criminal cases are then referred to Type of comments
CPS. * § No. However, CPS should not investigate criminal abuse cases. The CPS worker should let the detective
§ CPS should technically report to law enforcement, but handle it. CPS is not trained to investigate.
their idea of reporting it is basically faxing all the § Absolutely not.
reports over to child help. They fax over volumes of § No, we would need two more squads and there would be a need to have guidelines set up.
stuff and then say, okay we referred it to them but it is § No, we would have to have at least a half a dozen or a dozen investigators.
not a real referral per say. They do not prioritize those § No, every one in patrol would have to come up here, there is no way we could ever have that manpower.
referrals. § No, triple manpower or provide another police department.
§ I am not sure if any of them do. I think we have the § No, in cases of abuse, and especially sexual abuse, they should be cross-referring to law enforcement to
“best” child abuse statutes in the entire United States. take the lead in the investigation. In order for cases to have law enforcement in the lead investigative role,
CPS has to follow the protocol. I have had cases where they have not followed the protocol and it was
harmful to the case. If there is any disclosure made by a child regarding abuse or neglect, the police should
be contacted to file the report. In some of these cases, there are red flags. If law enforcement were to be
called out on every case then a lot more manpower would be needed.
§ No, I don’t think we should because of the man power that would be needed. It would be 4 to 5 times
greater than what we have in place right now. Our officers would overlap with CPS on issues. Law
enforcement should be called out on all cases of sexual abuse.
§ No, I would like to see CPS do neglects and real minor abuse cases such as dirty houses and stuff like that.
If we law enforcement were called out on all cases referred, more man power would be needed.
§ No, sometimes there are people who are down and out and they can't take care of their kids. In these
particular cases CPS can be very helpful in working with them. They just need intervention and help.
When you have situations that involve an act of crime or severe neglect, physical or sexual abuse, law
enforcement should be contacted and the case should be referred for a criminal investigation. CPS would
need to have more shelters available for these people in order to help them get themselves together and get
back on their feet.
In Harm’s Way
TABLE 16
Timeframes
Judges Police CPS Workers

§ There are firm time limits in § There is no standard timeline. § They are ranked in priority levels which take into account the child’s safety, age,
juvenile court for child abuse, Sometimes a case can take a couple of and where the child is at (home, shelter, hospital).*
child neglect and sexual abuse. months and sometimes a case can take a § We have a priority system in place. Priority 1: two hours to respond to the report,
They are found in Title 8 and couple of days to complete. We have a priority 2: 48 hours to respond to the report, a priority 3: 72 hrs to respond to the
Rules for Procedure for the case management policy that requires report and priority 4, five days to respond to the report. For investigations, CPS
Juvenile Court. the completion of a 30 day supplement has 21 days to investigate the allegation. Weekends and holidays count in the
§ There are no time limits in to the report. * response time of the 21 days to complete that investigation and they have 30 days
family court cases. § We have no standard timeline, in to close the case unless the worker can get approval by the supervisor to keep it
§ In family court, most of the custody cases; the paper work gets done open longer.*
cases are resolved in 6-9 sooner or later. * § Regarding home visits or investigations, the worker has to see the home at least
months, to allow for a custody § We have no standard timeline for once during the investigation and it can depend on what the allegations are. If the
evaluation/dispute, investigating a child abuse case. * allegations are that that the home is hazardous, then that is where your response
assessment, medical work-up. § Our timelines depend on how busy we has to be and it has to be pretty soon, and if it is a physical abuse allegation, it
are and how many “fires” we have to may be appropriate to the worker would see the child. On another case, if the
put out. child was seen at school initially and then the worker made a follow up visit to
§ The system is overwhelmed with too the child’s home then it would be an appropriate response for the investigation.
many cases and not enough resources In investigations, it depends on what the abuse or neglect allegations are.
but no one wants to talk about it. § Most workers spend less than 1 hour during their monthly visits.
§ We have to prioritize our cases based on
safety and risk factors to the child. Are the time frames adequate?
§ We don’t have a time line to complete a § Caseworkers are often pressed by the time frames outlined in policy. They cannot
case. For case management, we work do an adequate job *
the case as long as it takes. On a legal § Is the time frame adequate: Yes, I think it is adequate *
stand point there is a statute of § Timeframes need to be extended, we are at the mercy of other agencies to collect
limitations for a child abuse felony. data and/or deliver services. The other systems we work with should respond to
§ We are really concerned about the new our timeframes or CPS should deliver the services *
rule that is coming out, the exclusionary § I believe the time frames are adequate now, more so than in the past, we have a
rule. It is going to be problematic; rule pretty good compliance rate as far as that goes.
15 will pose a huge problem. § In investigations, it is a problem. We have 21 days to investigate a report.
§ There is no standard timeline. Only Detectives, who work abuse cases, have time to thoroughly investigate the
when an arrest is made or we have allegation of abuse. We are hurried to assess the dynamics of the case and then a
enough information on a case, we have determination to substantiate or unsubstantiated the allegation of abuse. Many
to submit the information within 24 times, we just don’t have enough time to work the case effectively and make an
hours of the arrest in order for the appropriate determination. We need more time to investigate our cases.
person to be charged. § In investigations, we have a time frame of 21 days and I do not know if we are
§ I am not sure if there is a time frame, allotted enough time, it depends on the resources.
but if so, I don’t know if I have ever § When we have police involved in the report, a lot of times it takes much longer to
met it. We try to get CPS involved in complete the investigation and we are no where near making a finding in thirty
cases immediately. days, even though we are supposed to be looking at closing the case. The police
§ The average abuse case can take up to do not have the same time frames that we do.
29 hours to investigate. § I would say no, probably because some of us are overwhelmed with cases. Then
§ Our caseload is fairly manageable. It is you can’t always be there. If we are unable to make visits, we make arrangements
a priority that you grab a case that is for other workers to help us out if they can. They could make the home visits for
real hot and fresh, you need to work on us. It’s pretty frequent.
it right away. A case where there is no § No the timeframes are not adequate; we are already having a struggle with a
physical evidence anymore and it heavy caseload.
happened years ago, but just recently § I think some of the timeframes are not adequate. I know of some cases where the
reported, it will take a back seat to the time frames have not been met. You have to respond to twenty different
hot cases that need our full attention commands. So, you are now responding to a case according to the timetable of
right now. what’s most important and what your feelings are in determining how to
prioritize them. In other words, what you feel is the most urgent to focus on first.
§ It depends on the severity of the report.
§ Depending on caseload, most CPS workers properly manage their time and
complete their monthly visits on time.
§ It depends on the case. In most cases it’s probably adequate. They don’t have
enough time to complete the required paper work. The priority response time to
investigate an allegation is sufficient.
§ Yes and No. It would be adequate if the number of reports that came in per week
were less or if the complexity of the report that came in were less. If we could
address the workload issues, I think the time frames would be closer to being
appropriate.
§ If the field needs to respond more quickly, I can find ways to bring this about.
In Harm’s Way
TABLE 17
Time Needed to Finish a Case?
Police
Initial contact
§ We need more manpower to ensure we get to these cases and the child is examined right away while the evidence is still fresh. *
§ If too much time is lost, you can loose evidence and the victim may not feel like going through with the case. *
§ We need to respond to the case as soon as possible, if the child is in the house.
§ It depends on allegations but within 72 hours.
Time need to finish a case

§ It depends on age of victim. The smaller the victim, the shorter the time frame (a few days), the older the victim, the longer the time frame, (a couple of weeks). A victim
over 12 years, (a month or two) as long as they are safe.
§ In working a case, the main goal is that first and foremost you must protect a child. We should be able to conduct a full investigation without time constraints. I think that
CPS needs to provide a safe placement for that child until our investigation is completed. CPS should be given a longer time line to keep a child in a safe placement. They
should not have to put a child back into an unsafe placement because of a 21 day timeline restriction they are under to complete their investigation.
§ I couldn’t say. Obviously, the sooner I can complete a case, the better. Usually, a case doesn’t go to trial for probably a year at best. In the past three years, we haven’t had
any cases go to a jury trial. It depends on the case, some take longer to complete than others. Some cases are more complicated than others to investigate.
§ It all depends on the cases and how much investigation is needed.
§ It depends on how fresh the evidence is when addressing a timeline. For example, are you talking about a two year delayed molestation case where you don’t have enough
evidence or in incident that happened last night? When the case is delayed, you may be able to collect other types of evidence. If you only had one case to complete from
beginning to end, three days to three weeks to investigate the case would be considered reasonable.
§ The number one issue is the re-victimization of the victim. If the case can not be responded to in an adequate time frame, you could fail in corroborating the child’s
disclosure. It can also affect your reputation because the parents’ call very upset that nothing has been done on the case. Another outcome a delayed investigation can
create is the problem of the offender being out there able to victimize other kids.
§ Obviously if an investigation is not done in a timely manner, it lowers the probability of it being prosecuted in the first place. People forget things or don’t want to be
involved in it after awhile. People say they just want to forget it and move on.
% of cases that fail to meet time line for investigation

§ A majority of the time, we don’t meet the time line.
§ About 99% of the time we fail to meet a time frame.
§ Approximately 75% of the time we don’t meet a time line.
§ In all of the cases. Truly, I don't know if a time line exists. For case management requirements the case is supposed to have a supplemental report in thirty days. It is a
policy, but we never meet it. We are never able to meet that timeline.
§ About 70% of the time, we don’t meet the police department timeline.
§ About 40% of the time we don’t meet department timelines.
In Harm’s Way
TABLE 18
Issues and Barriers
Police Foster Parents
Resources § Reunification should be prohibited to families that are

§ Lack of manpower is the main problem. Child abuse cases take a significant amount of time to still dysfunctional after one year. These families are not
complete; we have a current backlog. * able to meet the emotional needs of their children. *
§ Budget constraints are an issue; administrators don’t know the length of time that it takes to conduct an § There is a problem with poor communication between
investigation. They don’t understand that crimes against children are handled differently. * professionals who are a part of the system. Often, we are
§ We need to have an operational manager in our unit. not given adequate information prior to the child’s
§ If you went around and looked at all of the detective’s desks you would see stacks of video and audio placement. *
tapes. They all need to be transcribed and we have no support staff to assist us with this. § Rural locations are a barrier as case managers don’t want
§ The primary issue is money and financial support and leadership support. We need more support from to drive that far. *
our leadership and commanders to understand that child crimes takes a lot more time than other details § We do not feel that the Foster Care Review Boards are
and we need a case load that we can work effectively. effective *
§ Money, every thing is based on money. Patrol could benefit from money to promote officers and we § We see a problem with the turn over rate involving
could improve if we had more manpower. If more officers were on patrol then other officers could be caseworkers.
pulled out into detective positions. § It is a problem when the caseworker does not return calls.
§ The amount of time required to conduct a thorough investigation can create a backlog of cases. § Case workers are faced with heavy case loads.
§ There is a new law stating children should not linger in
Training foster care, yet many children linger which is
§ It is important to stay current on abuse and neglect issues, which makes continual training always an emotionally damaging.
issue. *
§ A real problem in rotating the officers. That policy should be lifted so we can keep trained officers in the
child abuse unit.
Evidence and false reports

§ We get cases involving a lot of allegations from one person to the other and vice versa. So it takes a
good detective to do a really good interrogation to get a confession and if that doesn’t happen, then the
case goes nowhere. *
§ The county attorney does not prosecute enough cases. If the case is not perfect, they won’t submit it. The
county attorney should take the chance even if the case is not perfect but certain elements are there.
§ Some people false report simply to manipulate the system. Alleged abuse can take a lot of time to
investigate and it can eat up a lot of the detective’s time when the report that has been made is false.
§ If we could have another two or three people doing investigations like this then it would be great.
In Harm’s Way
TABLE 18 Continued… Issues and Barriers
CPS Workers
Resources
§ We have a high caseload. *
§ The lack of manpower is an issue. It leaves the worker with not enough time to adequately investigate a case. *
§ If workers could concentrate in quality vs. quantity. We don’t have enough time to concentrate; we try to find ways to patch things up. The biggest problem is manpower
and caseload.
§ We end up doing the very minimum to help children and not to expend resources.
§ The poor pay of caseworkers is a barrier to recruiting and keeping a quality professional casework staff.
§ Our information database and record keeping is lagging behind. There is no integration of the computer systems so we cannot access comprehensive information or find
out what services a family received.
§ I think it would be better if we had option providers and we could get the services in place faster.
Job stress and knowledge
§ Across the board there is a high turn over rate. There is job related stress and heavy demands on workers. If a case blows up in the media, the workers don’t feel supported.
It is hard to maintain morale. *
§ The lack of training. Many workers come in with no experience in working with children and families.
§ The level of knowledge the field worker has regarding medical issues is less than adequate.
§ Another barrier is that we are just now implementing safety assessment tool and there will be a learning curve in using this tool.
§ We are not sure where the break down is; how many cases that should have been substantiated were overturned.
§ We operate in a crisis mode.
Family services
§ Mental health services are not as responsive to the family as they should be. *
§ The length of time too long to wait for services*
§ I think parents who are addicted to substances aren’t able to move towards recovery.
§ Parents not working with the case plan or with the case worker. A case manager we can do only so much with out other parties stepping in and helping out.
§ Our agency is lacking in contracted services for domestic violence.
§ We have some good agencies in our area that provide good services; but they’re not as experienced as they need to be in working with the complexities of the families that
we have in our system.
§ A lack of motivation on the parents’ part is a real problem.
§ I disagree with the policy that we are supposed to give kids brochures written on an adult level and not on a child level.
Lack of cooperation/communication
§ It seems like the goal of the system is NOT to work with other agencies and the community, they’re territorial and not held accountable. *
§ It seems that there is a distrust/lack of communication between agencies. *
§ Services may be duplicated from one system to another and there is no coordination of efforts between various systems.
Placement options
§ There are not enough placement options and too many children needing placement *
§ Shelters are not therapeutic and inadequately staffed.
§ There are a low number of adoptive families for older children.
§ Safe and timely placement options not adequate to meet the demand.
§ I question the quality of many of the group homes we have, there is no oversight. How do you know if a child is any safer there than in their abusive home environment?
§ The whole foster care system needs to be reassessed. The system may not be equipped to deal with children’s issues. There are not enough qualified foster homes to care
for children.
Legal/policy issues
§ For safety purposes, investigations can only document facts. It is difficult to remove a child without evidence (i.e. drug exposure, bruises, etc.)
§ Arizona is a parents’ right state vs. a child’s rights state.
§ Do they use a bar so high that the proof needed is unrealistically high? We wonder who plays a role in the decision making process and if the decisions made are in the
child’s best interest.
§ State statutes changed the adoption law for relatives; however commissioners and judges continue to practice old law.
§ The court decides certification of adoptive families vs. social workers. We should be able to have social workers who can certify adoptive families.
§ The judges ruling on placement to foster parents vs. relatives can be an issue.
§ The lack of consistency in judges’ rulings is an issue.
§ “Imminent danger” should be more specifically defined to result in more consistency in the handling of abuse cases.
§ The circumstances that define when to discontinue reunification efforts should be expanded; not to just involve cases of abuse. In cases of neglect, there should be grounds
to discontinue reunification efforts as well.
§ Courts making unrealistic demands on caseworkers to make things happen in a case (like mental health services) that we have no control over. We rely on community
agencies for services.
§ We need to prevent cases from falling through the cracks. We also need to find better safety and risk assessment tools to use throughout the case.
§ A case where mom is on meth, we dismissed the dependency because the child was going to stay with her grandmother. The mother could revoke the 6 month power of
attorney at any time and we would have to start over again.
§ The laws in this state protect families. We have family centered practice here.
In Harm’s Way
TABLE 19
Under What Conditions a Child Should be Reunited with a Caregiver Before the Police Criminal Investigation is Completed?
Community Service Providers Physicians & Medical

Social Workers
When they can provide a safe home and go through treatment. That’s basically it. * § When the risk
Type of comments: factors have been
§ When the family is accountable to providing a safe and nurturing home and support systems are in place. eliminated and
§ When caregiver has demonstrated and proven to be self reliant and capable of handling the child in a safe environment. When the caregiver monitored *
has demonstrated an understanding of child development, and they have proven to be self reliant, capable of handling their child in a safe § Depends on a lot of
environment. factors. When it
§ When there is assurance that the child will be protected and that the risk factors have been removed. does occur, it needs
§ If the caregiver is not doing the abusive behavior, whatever it is, doing drugs, hitting child, etc. If the parent receives a proper education and to be carefully
has a parent aid and the attitude of the parent has improved to demonstrate that they care about the well being of their child. These parents are supervised.
few and far between. The parent has to demonstrate a desire to take a more proactive role in protecting the child. § When the parents or
§ When steps have been taken to remediate the problem that brought them into care to begin with. One size doesn’t fit all. You can’t just say, guardians have
“Let’s send someone to a parenting class or get them drug or alcohol rehab, or all you have to do is get a job.” With these families, there acquired the
rarely is one single factor that brought them to the attention to CPS, so we need to work on more than one issue at a time with these families necessary skills to
and personalize the services to meet their individual needs. Once we think it is safe for the children to go back, we should have ongoing care for the children
monitoring of the case. The family needs follow up. § If the problem was
§ If something has been done to change the factors that caused the injury to begin with (change is the key word), If the reduction of those a crisis situation vs.
factors have been addressed and taken care of, then you can reunite the family. It is important to maintain contact with the parent caregiver chronic problem
and monitor the situation. Parents have to accept responsibility for the factors that caused the injury and demonstrated that they have done § Drug rehabilitation
something to reduce the risks that led to their child being harmed. completed.
§ Reunification can take place when the caregiver has complied to the case plan and all parties agree that the caregiver is truly prepared to take
on the stressful management and care that is necessary in reunifying the caregiver with the child. There needs to be continued close
monitoring at different times of the day and evening to make sure things are working favorably in the home. The monitoring needs to be
extended as long as it is needed, until the family is stable. On going monitoring is essential to make sure the family remains stable.
Monitoring the situation for a year and a half would be appropriate.
§ When goals are met for these parents to be able to care for their child. The goals should be realistic, measurable and monitored. The services
need to be monitored and further action should be taken in cases of parents who are not following through. They shouldn’t be given chance
after chance. Monitoring of the family is important to ensure that the goals are being met. Often, what we see is that after the case is closed,
the family resumes as it did before. Cases are not kept open long enough to assure child safety. The community should be involved.
§ Caregivers should have to complete parent training and prove they are capable of caring for their child. They should be able to gradually
come back into their child’s life.
§ Once we think it is safe for the children to go back, there should be ongoing monitoring of the case.
§ When the caregiver has done what they need to do (i.e. parenting classes, substance abuse treatment) and it is safe to return the child, the
family should be reunited. If these requirements are all met and the parents are actually making an effort to reach their designated goals, then
they should be reunited with their child. CPS should monitor the case to assess child safety.
§ Once the parents have demonstrated that they are going to properly care for their children and CPS can continue to watch them for a
significant amount of time after they have been reunited.
§ If the perpetrator in the family out of the home. Or, in a case involving domestic violence; mom understands that she has to change the way
the family has lived and accepts services, then CPS should keep the case open until they feel sure the family is on a right track. These kids
love their parents and if they can be reunited it is a goal worth looking at. However, when the parents are given chances and things have not
changed then kids should be moved into the system quickly and placed in a safe and healthy home.
§ If that caregiver has been able to maintain his or her support systems (seeking education, learning how to lower their stress levels, maintaining
lower stress levels) and being able to show that they are truly concerned and care about the wellbeing of their child and are willing to protect,
they should be able to move toward reunification.
§ Depending upon the particulars in the situation and depending on the type of abuse, if it was family situation or caregiver situation. I guess
the child should be reunited with a caregiver only after a period of time has elapsed pertinent to the particular case. There has to have been
supervision and education or treatment in the areas that the caregiver was lacking in. Reunification can take place only after every single
thing has been dealt with and people feel that the placement is safe and the caregiver stays connected to the system.
§ Only if the parent has reformed. If they have been given too many chances it just lessens the child’s chance of finding permanency.
§ Intensive, time-limited services should be given to parent who is up front successful in meeting the expectations of the case plan. At that
point, the child can be returned. If the goals are not met then parental rights should be severed so the child can find a permanent/ adoptive
home.
§ When the parent has improved, they still need to be monitored to be sure the changes are permanent and the child can be kept safe.
Other comments
§ I don’t know, I think that’s hard for CPS to determine. You want the child returned if they can care for the child. You’ll never know, I think
it’s hard for them to decide. I see parents say ok, they go through the system, they say I’ll do this and that and you are assuming they’re
following your directions and they’re learning what they need to learn. You return the child but you’re not sure if it’s ok for the child to go
back into that environment but I think it is the hardest decision you can make.
§ Why were they ever taken away from the caregiver? Was the caregiver the one who abused them? This is one of the problems; the child
should not have been taken away from the caregiver unless the caregiver was the one who was actively doing the abuse. They should be
reunited immediately. If the caregiver was the one who was actively being abusive, then they should be reunited when the caregiver is held
accountable, received appropriate services, and acknowledged that they had done something wrong.
In Harm’s Way
TABLE 20
What Should be Done With Babies Born Substance Exposed?
Judges Prosecutors Police CPS Workers Foster Parents Community Physicians & Guardians Ad
Service Providers Medical Social Litem
Workers
§ If home is § It should be § It is a crime. * § There should § Babies born § It is a crime. * § When you § The baby
safe, a parent a crime. * § Remove the be close substance § Criminal have should be
should be § It is child baby from the monitoring of exposed charges somebody tested for
given a abuse; mother and the families. should not against that is putting drug and
mentor should be place in The parent leave the parents, take a baby in a alcohol
parent to at least a protective needs to be hospital the child away perfect meth exposure
assist, along Class 4 custody held with that until mom lab which is before
with Family felony. If pending accountable. * parent. It is cleans up with the uterus, it leaving the
Builder you assault investigation. § We need clear better to mandatory should be an hospital.
services. a woman * guidelines to disrupt the treatment. * automatic CPS should
§ Move to and kill the § Prosecute handle these bonding § Babies should trigger. step in right
swiftly baby in the mothers who cases. * issue than go into CPS § I consider in away and
remove the womb, you use drugs § Would not have an care when a utero drug get services
child from can get heavily and support blanket abused parent has a abuse child going, if
the person(s) time for it; don’t return removal. child. * history of abuse and they don’t
who would what is the the child to § Assigning § The child having much more, comply –
seriously difference? them until mentors to should be substance that baby is at severe
endanger * they are families when removed exposed a greater parental
their lives. § CPS can clean. * a long drug and placed infants * risk.* rights. *
§ The child and should § If you have a history exists for § If there was § Babies should § It should be
should be remove the baby born for the parent. adoption as more money, not have to reported
kept in the child from with cocaine § Court the mother more services go home and and the
hospital as the parent or meth in mandated will should be prove they parent
long as using drugs system at the treatment.* probably provided up are safe in the should be
possible and * time of birth, § In-home not have front. * home. offered an
receive all § There parents have dependency any more § The parent is § The baby in-house
necessary needs to be no business and safety concern for in need of should have a treatment
medical some with their kid. planning the child. * close medical home health program to
services. protocol * § Make it a law § CPS should supervision nurse to attend with
§ Public policy for § Offer more that it is a investigate and family monitor the her child. *
is better left mandatory services to crime.* these cases. monitoring * child on a § The parent
to the drug mother, make § Provide more § Parents § Provide regular basis must be
Legislature. testing and welfare preventive should be services to the with held
§ We don’t do medical contingent services during criminally parents for coordination accountable
anything for follow up upon staying pregnancy. prosecuted. drug and and better
fetal alcohol with kids. * "clean" and treatment. * information available
§ I would like to
syndrome, § There are providing a see the policy § We need to sharing with treatment
but need to; no laws to good home have the hospital. * programs
changed we
research prosecute a for the child. have an interim mandatory § I consider in are needed.
indicates mother § There has to policy came to treatment and utero drug
those who harms be a law like effect after the hold the exposure
children have child in the the one in Andreah case. I parents child abuse.
a greater womb. California. A think the accountable. * That baby is
tendency to § Changing baby who is agency did a § It should be at much
be violent the law substance knee jerk dealt with greater risk.
and act out in could exposed reaction. through CPS If a woman
a sexually change the should be a § We need to policy and did not care
inappropriate right to felony child look at all the consequential enough to
manner. choose to abuse class 2, factors. There action. No law stop doing
§ We need to have an for the are some changes are this when she
know more abortion. mother who parents who needed, just is pregnant
about what used the are able to enforce what with a child,
happens to substances parent their we have. is there any
substance during her children who § I don’t think hope that she
born children pregnancy. are using the answer is will be able
to determine drugs. to yank the kid to parent a
a policy of child? I don’t
§ We need a law away from her
handling parent and think so.
to determine
those cases. the risk and throw the kid § There should
classification into a foster be mandatory
as abuse or home. compliance
neglect. § The parent with services
or the mother
§ A should lose
her rights to looses her
comprehensive
her child. baby. *
needs
assessment § The safety of § Criminalize
should be the baby abuse and
performed with should be give the
the input from evaluated first; parent a
the medical mother should chance to
staff. be sober. She plea with
court
§ Provide more should get out
of that kind of mandated
education to
environment. services. *
mom.
§ I think that in § A lot of these
all cases and kids would do
on all levels, well if they
children went into
should not be alternative
put in harms placement.
way. I don’t § You have to
think people look at other
do a very good factors that

job sometimes affect the
of determining unborn child
what is in including:
harms way. pre-partum
§ Better means nutrition, pre-
of birth partum health
control should care, pre-
be looked at partum
including lifestyle on
sterilization the part of the
for these mom, all of
mothers who these can
deliver have an affect
multiple on the fetus
substance- along with
exposed pre and post
babies. natal drugs
§ A mandatory and it is hard
parenting to sort it all
course for out within a
first time drug infused
parents. family.
§ These people
chose drugs
over their
baby; it is a
tremendous
risk factor
and abuse.
§ These babies
need
protection.
§ It can
adversely
affect a baby.
In Harm’s Way
TABLE 21
Recommendations
Questions Judges Prosecutors
Systems changes to Resources Resources

improve state § More resources available for parents to get help * § More manpower is needed and we need to be able to work more
response § Provide adequate resources for professionals to do their job. * closely with CPS. *
§ More available mental health services. * § More funding for officers in their unit, crime lab, homicide
§ We need more foster parents. cases and abuse cases. *
§ Remove workers who are not committed and dedicated. § Our caseloads need to be reduced. *
§ Provide legal representation for children in these cases. § It needs to be easier to get CPS reports and to access
§ Improved prenatal care information instead of filing motions and arguing with people;
§ I believe the tools already exist to act efficiently as possible. reports not turned over without court order. *
§ Resources are needed to provide for legal representation for children in § We need more prosecutors to handle the caseload and to hire
family court; and for additional counselors and evaluators. investigators in our agency to follow up on cases that police are
§ Funding to order “risk assessments”. not able to.*
§ More funds for experts, we need more training for attorneys. *
Policy § CPS needs more money and they need to be given more
§ The key legal and judicial issues depend on the type of case. In all cases, flexibility to enforce safety.
the child’s safety should be the paramount concern. § Police assist and co-work cases often.
§ Look at all available research, as well as best case practices and
determine what is appropriate. Policy
§ Juvenile sex offenders should not be transferred to adult court if it can be § Start with CPS, our biggest concern; again change the focus
demonstrated that they were victimized so that they can receive adequate from unification to protection of the child. *
training. § First goal – make child safe, second goal-investigate, third goal
§ Ensure foster children at age 18 may voluntarily remain in system to counseling and services, fourth goal-reunification.
finish their education, etc. § Caseworker should have the discretion that a child is in
§ Make divorces an administrative process unless there are allegations of imminent danger to make a decision with some degree of
abuse or neglect. amnesty. *
§ At times, children are required to testify, which is rarely in their best § Parents should not be allowed to refuse services.
interest in these types of cases. § Other jurisdictions don’t contact us as soon as they should or
§ Need for time limits in family court. even if you do get called you get called late.
§ Mandatory and combined training and certification on abuse issues for § CPS assessment tool is not working.
social workers and law enforcement.
Law changes
Law changes § Mandatory reporting law; needs to be less “wiggle room”
§ For the legislature to decide. § What CA does with DV, AZ should with do with DV and child
§ Statutes are not the problem; it’s the lack of interest if there is no police abuse, make it easier through our evidence code to be able to
involvement. bring out prior incidents of child abuse with out having to jump
through loop holes.
Prosecution issues § Declare prenatal and perinatal use of illegal drugs to be the
§ Law enforcement should tape record all statements of suspects. Ensure crime of child abuse.
that professionals interview the children. § I don’t know why you can assault a stranger and it won’t go off
§ Attorneys should all be prepared to try the case as soon as possible. your record but assault a family member and it can be cleared.
§ Lawyers need to take the time to fully investigate the facts and advocate § If maybe we modified 3601 M and limit the ability it is used it
for the best interests of the children through their eyes. may be helpful. It could be modified to be at the discretion of
the prosecutor.
Prevention § CPS doesn’t have the statutorily ability to remove the children
§ Parenting education in schools. * that need to be.
§ Childcare and living wages.
Prosecution issues
§ What needs to change is the attitude of our jury panel so they
understand children are not the property of their parents.
One or two § Provide adequate resources * § More efforts toward prevention, public education *.
recommendations to § Sufficient training. § More money, more manpower
improve § Ensure people who work in this field really care about kids and not § Be able to use prior reports of abuse in home as evidence in
safety/protection process. current cases
§ Look at all available research, as well as best case practices and § Mandatory classes for parents on child rearing.
determine what is appropriate for Arizona.
In Harm’s Way
TABLE 22
Recommendations
Question Police
Systems Resources
changes to § Need more manpower/overtime to work the cases on a timely basis, limit caseloads. *
improve § CPS needs to have more funding and higher pay so they would get more competent caseworkers. *
state § Not enough placement options or treatment when you do have to place them. *
response § That is when it comes down to priorities, they have to be willing to cut other departments and let us do our work to protect children. *
§ Need more services/resources for people. *
§ We need a police child abuse unit that deals with the school districts.
§ There should be a centralized database where all information relevant to investigating cases can be accessed.
Policy
§ Better training for patrol more accountability within department on protocol. *
§ Detectives should be able to go out on every case, so that the case can be done properly the first time. *
§ Should have a protocol as a state standard, you could have more agencies working together and on the state level we could all be mandated to handle cases
in a certain way. *
§ Policies are there; the problem is they are not always enforced. We aren’t able to follow protocol. *
§ Child Protective Services should get rid of their 21-day time line to investigate a case and follow lead of the detectives. The detective should be the first to
interview the parent. *
§ Need a better system of evaluating kinship care placements; you can’t just rely on background check.
§ A lot of our cases come from different jurisdictions. Due to the procedure to travel and meet up with these families, we have to go through a lot of paper
work and wait to get approved for travel.
§ Increase collaboration between agencies.
Law changes
§ Neglect laws need to be clarified and strengthened (too vague). *
§ Need to legislate coordination of protocol and timelines between CPS and PD.*
§ Another law that needs to be tougher is our stand on substance-exposed babies. *
§ Higher class felony charge for continuing maltreatment of a child, or multiple incidents of abuse or neglect.*
§ Have graduated laws that show the difference between a 16 year old and a 40 year old, or a 14 year old involved in Internet sex with a 40 year old. Or a
law specific to handling the difference between a 15 and sixteen year old having sex as compared to a 16 year old having sex with a 50 year old. *
§ The legislation should change the primary goal of CPS to child protection and not have them focus on the case plan of reunification; rather the case plan
should be protection of the child. *
§ CPS should have the authority to remove kids sooner than what they are able to do.
§ Supreme Court just ruled that computer pornography is okay. It needs to be against the law.
§ The physical abuse needs to define the type of mark on a child that constitutes abuse and define whether a mark needs to be a permanent mark or a
temporary mark or an abrasion to make it clear.
§ Mandatory reporting statutes as far as the religious community is concerned and what they are required to report on.
§ Peeping Tom laws need to be strengthened.
§ The CA charging standards needs to be more clarified. And when it comes to cases of parents smoking crack in front of children, we need to have the CA's
office charging standards clarified.
Prosecution issues
§ All in all, the laws are pretty tough; we just need to follow them and use common sense. We need prosecute more cases. *
§ The county attorney’s office has to take more cases and have consistent policy within the office when reviewing cases.
§ False reporting needs to have more serious consequences and be prosecuted. *
§ DUI laws, if you reach a certain alcohol level you will be prosecuted, domestic violence laws are the same and crimes against children filing guidelines
should be standardized as well to get them to file more cases for the best interest of the child.
§ Rule 15. It will effect investigations and serve as a defense that we didn’t conduct a proper investigation.
§ Judges need to stop letting kids be raped again on the witness stand when they are cross-examined.
§ The other problem that I think the judges’ run hot and cold on bonds.
Prevention
§ More has to be done in the area of prevention, educate the public, media, and kids about the definition and scope of child abuse, public information
campaign. *
In Harm’s Way
TABLE 23
Recommendations
Question
CPS Workers
Systems Resources
changes to § The state must provide adequate human resources to do the job CPS is called upon to do. *
improve § Community needs better resources for marginal families. Tap resources to parents who have parenting skills and people who are available to care for kids.
state *
response § Maricopa County should have an adoption, or referral worker, so I don’t have to find our foster families. Difficult to keep up with cases.
§ Group homes should be model facilities as an ideal alternative, bring back good orphanages *
§ Higher quality shelters with better-trained staff.
§ Show how money is being used for children.
§ Juvenile probation no funds for their foster homes. We have to provide. Pay for their systems.
Policy
§ If a mom delivers a substance-exposed baby then she should be mandated to stay in a treatment program. *
§ Value Options must be held accountable for providing timely, quality mental health services. *
§ For our agency we have issues and we need to find a way to better serve the needs of families and children and to better protect children. *
§ Widen circumstances defined to discontinue reunification efforts; not just abuse, but neglect to be grounds as well.
§ Mandate forensic training for all CPS staff.
§ Integrating medical staff personnel to collaborate and receive information to improve our formulation of the case plan.
§ Mental health services should be revised by early identification of “at risk” babies.
§ I would change substance abuse treatment and the whole substance abuse treatment model.
§ Better organized response to marginal families, either stronger Family Builders, county resource systems through schools or healthy families.
§ Safety assessment tool use needs to be monitored and utilized well.
§ Time frames need to be more flexible.
§ Need to look at how reports are being substantiated.
§ We give kids who are able to read, very large brochures that talk about what our job is on an adult level and not on a child level --scares them.
§ Give CPS ability to mandate services.
Law changes
§ Neglect needs to be more clearly defined, families held accountable *
§ The child should be the biggest priority, not adults. *
§ Substance exposed newborns should be specifically addressed by the law. *
§ Define “imminent danger” more clearly *
§ Tougher penalties for the crimes committed, laws stricter on child molesters. *
§ Reinvent the foster care system, group home make it a priority. Monitor them; the children are not being listened to.
§ Remove CPS from DES.
§ The laws need to be looked at differently to govern us. Accountability, monitoring should be increased. A lot of the times its management problems.
§ CPS under the umbrella of police department. However, concern is that system would become more punitive.
§ Group homes need to have the authority to keep kids from running away.
§ Would like to see Level 4 priority cases have mandatory classes or services.
Prosecution issues
§ Better prosecution of abuse cases by county. 100% investigation. *
§ Courts need to take big picture into consideration and enforce the law while taking into consideration best interest of child.
§ Law enforcement should be involved in initial investigations.
§ For law enforcement, I would like to run across more officers who are willing to take more reports of physical or sexual abuse.
§ Officers need to respond a little quicker when the alleged perpetrator is in the home.
§ Better training for those who are enforcing the laws.
Prevention
§ There is just need for more education, making sure that services are available for these families and being able to educate the client in all the resources and
increase community involvement. *
§ Place an emphasis on lifestyle, nutritional intake, especially in young children and babies and gain a better understanding of medical conditions.
In Harm’s Way
TABLE 24
Recommendations
Question Community Service Providers
Systems Resources
changes to § The first thing they need is more money. The case managers have so many cases, they are extremely short staffed. *
improve § Improve competency, training, and retention of CPS workers. *
state § Foster care parents need to be increased and improved upon and positive incentives and expectations. *
response § Improve mental health services. Adequate mental health and therapeutic group homes must be developed. *
§ DUI fines raised and revenues sent to CPS.
Policy
§ Whether law or policy, CPS should be empowered with clear guidelines for removing a child from a home, should be able to intervene based on a
preponderance of facts/evidence. *
§ Improve collaboration in the system where professionals involved in these cases are a part of staffing and their concerns are incorporated in the case plan. *
§ Change mechanism for children to get medical and/or resources needed in a timely manner. *
§ Create a team approach to case planning to prevent arbitrary decision-making by CPS, mandated multidisciplinary teams, more extended monitoring of
cases. *
§ Look at the way we calculate the substantiation rate. The way they categorize all the different cases.
§ Clarify and follow stringently all CPS policies and monitor that there is consistency in the agency’s adherence to policy.
§ Reorganize CPS to assign one worker to shelters so we have one point of contact.
§ CPS needs to consider all factors. They need more factors to look at when assessing the severity of a referral. And they don’t look at the whole picture.
§ Caseworkers spend an enormous amount of time trying to get the kids eligible for some kind of treatment or services. There shouldn’t be so many layers.
§ Develop a better way to track families who relocate, don’t unsubstantiated cases where family moves during investigation. Have file in central database, so
vital information is not lost.
Law changes
§ Neglect and chronic neglect should be clarified and spelled out (presumption of neglect and abuse). *
§ Move beyond reunification for severance or another avenue to keep children safe, balance between parent’s rights and children’s rights need’s to be
reprioritized. *
§ Criminalize the child abuse law to include substance exposed newborns.*
§ More to be done to mandate services and to be able to act on it when a parent doesn’t follow through, to help the child. *
§ Parents should be held accountable and/or prosecuted for abuse or neglect, harsher laws. *
§ More should be done in situations where a professional fails to report abuse when they are aware something is going on. *
§ Create clearer roles at CPS and for community providers. There has to be accountability, none as it stands now. There is no accountability for the judges,
no accountability for CPS. *
§ Give CPS ability to remove substance exposed newborns and mandate treatment services. *
§ Penalties for abuse and repeat abuse should be increased and enforced.
§ Physical abuse including shaken baby syndrome should be more specifically clarified in the laws.
§ The laws need to be redefined so domestic violence comes into play.
§ Pull CPS out of DES and put it with behavioral health services for kids. Have one system that directly deals with kids instead of several bureaucracies such
as DES and DHS, etc.
§ Have CPS director report to the Governor.
§ Interagency coordination between DES, DHS, Police and courts needs to be institutionalized.
§ Mandate parenting classes for new parents or certification course for parents.
§ Our welfare laws need work.
§ Children need to be in school and schools districts need to be held accountable for monitoring truancy and keeping kids in school.
§ Laws that recognize the sanctity of the relationship between siblings. More efforts need to be placed into keeping siblings together.
§ When child free for adoption, transfer custody to private agency.
§ Arizona is the only state that does not allow social workers to certify adoptive families and they should be.
§ The appeal process needs to be revamped. They have a higher criminal standard than criminal court.
Prosecution issues
§ The court lacks education regarding substance & emotional abuse and what works with these families and what doesn’t work. All parties need to be
educated. *
§ There is not enough information sharing among CPS and agencies involved and collaboration on these cases and this can hinder how CPS manages a case
and the outcome of the case.*
§ Law enforcement and CPS need to improve how they communicate with one another. They do not always cross refer. Maybe PD can have access to the
central registry and CPS can have access to some police information. It would be nice to see CPS officers go out together on these calls.*
§ At the first time in court, judges should be clear of the expectations of the parents and put it in the minute entry.
§ One of the things would be attitude. Patrol officers who go out do not often have the skills to assess family violence situations.
Prevention
§ Funding, health care, spending more on prevention: teen pregnancy, day care, parenting, substance abuse, and mental health information. *
In Harm’s Way
TABLE 25
Recommendations
Question CPS Workers Community Service Providers
One or two § Community education to help people to know when to § Child’s safety first over reunification. Zero tolerance. Too many cases where
recommendations report and how to report. Better community awareness and there is documented evidence of serious abuse and neglect and CPS continues
to improve to recognize what abuse is. * to leave children in those homes. *
safety/protection § More funding, more manpower, increase salaries to produce § More public education and prevention resources including identification of at-
better employees * risk families *
§ Triage each child that comes into care. § Hire more educated caseworkers, increase training and increase their pay,
§ Increase resources for mental health services. decrease caseloads *
§ Recruit more ethnic minorities to be adoptive families by § Education of ALL professionals on substance abuse, family violence, child
making it a more comfortable process. abuse, DV, cultural sensitivity, etc. - (teachers, doctors, judges, etc.) *
§ Greater focus on core issues. § Create a team approach across disciplines and agencies in making better
§ A lot of responsibility needs to be placed on the decisions and providing services for children. *
prosecutor’s office to put into place a higher standard of § Lobby for adequate funding for services and programs to help these children,
plea agreements and to not be afraid to go to trial on cases. including wrap around services for families. Consolidate programs. *
§ Work on gaps between law enforcement and CPS, e.g. § More early intervention and investigation resources, adequate assessments,
investigation timeframes. immediate triage for children, and short time frames for resolution. *
§ You need to go out to the field to case manage. § More foster care homes are needed. CPS needs to be able to recognize and
respect good foster families. They also should place kids closer to where they
live.*
§ More funding for shelters for woman and children along with a CPS
caseworker assigned to each shelter. *
§ Mandated parenting classes for developmental needs of a child and
expectations and it gives parents support. Helps parents to connect with other
parents so they are not so isolated. Involve the community in a large scale
mentoring effort to help. *
§ Do a better job with Social Work students at the universities. Most of them
want to run from CPS. We lose our best social worker students.
§ CPS putting exceeding pressure on aging grandparents to care for the child
when they are not able to do so. They try to force them into it. Once a
grandparent says yes, they get little support.
§ The worker should not change as frequently as they do on these cases. This
whole system of transferring workers on this child has got to stop.
§ I think this state undervalues their children and they have no rights. We need to
get the people in the system that care about children and give them a voice.
In Harm’s Way
TABLE 26
Recommendations
Question Physicians & Medical Social Workers
Systems changes to Resources

improve state § Improve the quality and skill level of CPS workers.
response § Staff hospitals with CPS workers who understand medical terminology and can be the point people for the medical team and CPS system.
§ There must be an improvement in resources for safe and adequate discharge planning of medically at risk kids. CPS must be reorganized,
restructured, re-staffed and adequately staffed.
§ I would try to have a better education of all the people involved in this. All need to know what each other is doing and what the medical staff is
doing and vice versa.
§ AHIT (After hour’s investigative team) doesn’t know us and we don’t see the kids from AHIT. The Child Help Center is a great concept because
we are able to work together better without all of the barriers in getting these kids into medical care.
Policy
§ Better communication between the agencies and a real collaborative effort between the systems that would be more of a multi-disciplinary
approach. *
§ Implement clear policies
§ Evaluate reunification standards
§ Create a new category to record families who move from unsubstantiated to unable to locate.
Law changes
§ Better laws to protect children not parents *
§ Confidentiality laws must be reviewed. Physicians & hospitals must have access to information to treat children medically and adequately. *
§ There must be clarification of custody/ guardianship statues when abused children are hospitalized. Legal status must be guaranteed to provide
medical caregivers the ability to treat status guaranteeing protection and safety. *
§ Placing family preservation second and child safety first
§ Not being able to conduct sibling exams is a problem. We are concerned about siblings who are never checked when a child in the home is
discovered to be abused.
§ Neglect law re-evaluated and improved
§ Laws to mandate services and to be able to act on it when parent doesn’t follow through
§ Mandate multidisciplinary teams, more extended monitoring of cases
§ Harsher child abuse laws, criminalize substance-exposed abuse and mandate services through pleas.
§ Currently the hospital has the burden of caring for kids subject to risk of being taken out of hospital by potential abusers.
§ Would like to see neglect criminalized. Neglect kills more children every year than shaken baby syndrome does and yet a lot of these cases result
in misdemeanor status.
§ More attention paid to drug exposed neonates. It is not illegal to expose your baby to lethal substances and it should be. If it is illegal, people may
not come in for medical care and that is a concern.
§ Mandate a better CPS tracking system.
Prosecution issues
§ Better investigations including the use of medical documentation of opinions.
§ With respect to law enforcement, CPS and our work, we should compliment each other and we could make their job easier and they could make
our job easier.
§ Unfortunately, both CPS and Law Enforcement have a lot of control over what children we can examine here and evaluate here and I think it is a
real big problem. If they don’t bring them, we can’t see them.
§ One of our goals is to make forensic medical exams part of the protocol in assessing for abuse and neglect. Law enforcement, forensics and CPS
are three parts of the wheel we all have our roles and we should compliment each other.
§ We need to focus on risk factors and prevention. Teaching kids life skills is helpful too. More ads in media about positive parenting, positive
One or two conflict resolution. *
recommendations to § Welfare of children needs to be put before any political agenda. *
improve § Do not leave siblings of abused children in home.
safety/protection § Children’s safety placed above family preservation.
§ Create centralized system to track children in system.
§ Improve communication between all professions involved in these cases.
§ CPS- too many legal ramifications and constraints, more power should be given to them so that they can make decisions regarding the care of the
children without fear of losing their job or legal ramifications.
In Harm’s Way
TABLE 27
Recommendations
Question Foster Parents Guardians Ad Litem
Systems changes to Resources Resources

improve state § Improve mental health services. § CPS is in need of more case workers and more money for services.
response § Higher reimbursements; more clothing money. § More tax money devoted to the issue.
§ Foster parents need more respite time each year. § Higher salary for case workers, better education, need better than
§ Foster parents need a cost of living raise. minimal adequate case workers.
§ Some children need a special advocate for educational purposes (not
just a surrogate parent). Policy
§ More CPS personnel & mental health workers need to be hired. § Home should not be preserved at all costs, we wait too long to file
dependency.
Policy § Get all departments together and interacting.
§ Improve screening of new parents. Perhaps have seasoned foster § Case workers carry too much power
parents be mentors for newcomers.
§ Payment process is not supportive to foster parents. Very difficult to Law changes
obtain foster care reimbursement. § No laws to be changed need policy changes. *
§ Better communication with G.A.L. and child’s attorney. § Put the child first – Not the parent.
Law changes Prosecution issues

§ Better laws to protect children. * § More resources, reports need to be investigated promptly and
§ Establish appropriate laws and funds to effectively accomplish thoroughly, standards need to be changed.
protection of children, and then employ necessary personnel. § More aggressive approach by the system, they need to make parents
§ Good laws already in place; the problem is enforcing them. more accountable for their actions, be it jail or a fine, require more
§ Laws need to provide immediate removal when neglect or abuse is than minimal parenting skills of parents.
substantiated and drug use is present. § Court systems are archaic – Have meaningful hearings – no one has
§ Follow a 3-month period of noncompliance for strictly monitored all the info they need – they are just cattle calls, bottle necks in
education, rehab, etc court.
§ Courts need more authority to order services.
Prosecution issues
§ Better investigations, quicker removals. Prevention
§ Parents must only possess minimal skills – they are way too low.
Prevention
§ Change the mental health system to be more “proactive.” Services
need to be provided to people/kids before they are in the “system.”
One or two § Provide more parenting classes and information and make it § Giving lip service on protecting children. We are not adequately
recommendations to mandatory. * providing services.
improve § Everybody involved in system take responsibility to do their job. * § Increase budget of CPS caseworkers, better training.
safety/protection § Change laws to immediately protect the child and continue to protect § More resources and training available on drug abuse, domestic
them in the future. violence, child abuse and private investigators available. GAL’s
§ Track allegations from state to state. can’t do job effectively without services being available to them.
§ Act on substantiated abuse/neglect cases immediately. § CPS needs to be held accountable for the policies they do have CPS
§ To really look for ways to get the community involved and to reach needs to disclose everything to GAL. CPS policy manual should
out for the brightest potential and really try to help these kids achieve. be available to GAL’s.
§ Look at resources and pay workers, increase man power. § Make the parent more accountable for their actions.
§ Increase efforts to prevent abuse from occurring in the first place.
CHAPTER SIX: ISSUES AND COMMENTARY
As the foregoing “voices” make clear, there is substantial frustration with the current system. To
understand in more detail the sources of this frustration let us examine a few critical issues.
The Law in Practical Application
The following cases are examples of how our child abuse and neglect laws actually are
administered in the real world. They address termination of parental rights, and babies injured by
exposure to illegal drugs and alcohol. The cases help illustrate the context in which professionals in the
field have formed the opinions and recommendations about the “system” we saw in the last Chapter.
Importantly, they raise issues which we must resolve if we are to focus more clearly on the threshold
duty of protecting children from criminal abuse and neglect.
Termination v. Reunification Efforts
In the Minh[99] case, horrific facts lead to haunting questions:

On May 14, 1999, at around 7:00 p.m., Minh called police and told them that
her daughter, Christine, was not breathing. When the police arrived at the
home, they found Christine dead, covered with bruises and lacerations. The
family told the police that on the previous afternoon, Christine had come home
from a walk at a construction site with bruises and other injuries. They said
that Christine was babbling and could not explain what had happened to her.
Minh and one of her daughters then bathed Christine and placed her in a
"prayer room." Tung came home from work around 7:00 p.m. and they began
to rub oil on Christine's body and pray for her.
Early the next morning, Tung got up for work and went to the "prayer room"
to check on Christine. He found Christine cold and clammy, and she was not
breathing. Tung attempted cardiopulmonary resuscitation on Christine but told
police that he knew she was dead at that point. The family continued
resuscitation efforts and also prayed for several hours, hoping that Christine
would come back. The family finally called the police that evening after a
relative convinced them to do so.
The police classified Christine's death as suspicious and the next day ADES'
Child Protective Services ("CPS") division took the other three children into
protective custody, citing the failure to seek medical attention and the delay in
reporting Christine's death. On June 29th, Minh gave birth to a son, and CPS
took him into custody immediately.
Because of the severity of Christine's injuries, Minh's and Tung's failure to

seek any timely assistance, evidence of possible sexual abuse of two of the
daughters, and that this was the family's seventh investigation by CPS, the
original CPS plan was severance and adoption. However, when the case was
transferred to another caseworker a few months later, the plan changed to
family reunification. CPS offered Minh and Tung services such as counseling,
psychological evaluations, parent aide services, including parenting skills and
training, and domestic violence counseling.
Minh and Tung were eventually arrested and incarcerated in connection with
Christine's death. CPS continued to offer Minh and Tung reunification
services, including finding an Asian Buddhist psychologist to counsel Minh
and Tung in jail and assigning them a parent aide. Both Minh and Tung
initially agreed to participate in the services; however, they later decided not to
participate upon the advice of their criminal defense attorneys. CPS informed
Minh and Tung their participation in these services was extremely important to
the family reunification plan, and that they would not be reunited with their
children if they did not participate. But the parents refused, citing their
attorneys' advice.
In April 2001 the juvenile court ordered the termination of the parent- child
relationship between Minh and Tung and their four children. Minh appeals the
severance as to all four children, and Tung appeals the severance as to the two
daughters.
Parents have a fundamental right to raise their children as they see fit, but that
right is not without limitation. Graville v. Dodge, 195 Ariz. 119, 124, ¶ 20, 985
P.2d 604, 609 (App.1999). The State has a right to protect children from
abusive parents. See id. And to protect children from abusive parents, the State
may require therapy and counseling for the parents. See, e.g., In re Welfare of
J.W. and A.W., 415 N.W.2d 879, 883 (Minn.1987) (holding that the State may
compel abusive or neglectful parents to undergo treatment).
Minh discloses profound policy flaws stemming from the sometimes competing interests found in
the current law and procedures. Certainly the court is correct, according to the issue that it
fundamentally decided, that a parent cannot hide behind the Fifth Amendment to refuse reunification
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EXHIBIT D
David Frodsham DUI

Indictment
EXHIBIT E
DCS Records of Abuse

Concern ID 1901
Concern Tj'pe: Licensing Issue
LicenseelD 5286
Licensee Firstname David
Licensee Lastname Frodsham
Progress Note Date Comments Time Entered by

03/22/2007 FINAL INQUIRY REPORT received from licensing worker, Adrienne 14:12:00 Bonnie
Kuntz. She found that the foster parents admitted to placing the Richter
child in handcuffs for one night t>ecause there was no intervention
or assistance. The child, Ryan, had gotten out of his room one
night and cut the foster parent's older daugther's hair while she
was sleeping. The foster parents were told that they were never to
use handcuffs with a foster children and th s was an inappropriate
technique. An Immediate CFT was held to discuss the problems In
the home. Tyan's therapist was there and changed Ryan's
medication to see If that would solve his Insomnia. The Frodshams
are in the process of adopting Ryan and his two siblings and they
are committed to the care of the children. In addition, the
Frodshams have a new adoption worker and will have more
success in obtaining services for Ryan. The Frodshams did not hide
the fact they had used the handcuffs and notified the agency
immediately. There Is no corrective action other than policy review
and stern warning this Is Inappropriate behavior and against
policy. A letter is being sent to the foster parents with the
concerns noted regarding inappropriate restraint. 01/12/2007:
LICENSING CONCERN: Today, 01-11-07, It was reported that
foster child, Ryan, gets up in the middle of the night and he
wanders throughout his foster home. Apparently, when Ryan was
roaming the house in the middle of the night he found scissors and
cut the foster parents older daughters hair off while she was
sleeping. The foster mother was worried Ryan might hurt someone
in the home so she handcuffed him to his bed at night until until
she was able to put an alarm In the home. The foster mother told
her therapist, Carol Galanos, what she did. The foster mother was
told she could not use handcuffs on any foster child. The licensing
worker found out what happened and she spoke with the foster
mother, too. Ryan's case manager Is NoemI Ochoa and she can be
contacted at 520-432-5652. The case mannger has been notified
of this information. Submitted licensing concern to agency for
furtiier Investigation.
01/16/2007 01/12/2007: LICENSING CONCERN: Today, 01-11-07, It was 0 8 : 1 2 : 0 0 Bonnie
reported that foster child, Ryan, gets up In the middle of the night Richter
and he wanders throughout his foster home. Apparently, when
Ryan was roaming the house in the middle of the night he found
scissors and cut the foster parents older daughters hair off while
she was sleeping. The foster mother was worried Ryan might hurt
someone in the home so she handcuffed hirn to his bed at night
until until she was able to put an alarm In the home. The foster
mother told her therapist, Carol Galanos, what she did. The foster
mother was told she could not use handcuffs on any foster child.
The licensing worker found out what happened and she spoke with
the foster mother, too. Ryan's case manager is Noemi C^hoa and
she can be contacted at 520-432-5652. The case manager has
been notified of this information. Submitted licensing aincem to
agency for further Investigation.
Concern ID J49403
Couceni Type. Licensing Issue
T. i c e n s e e l D 5286
Licensee Firstname David

Licensee Lastnanie Frodshain
Progress Note Date Comments Entered by

01/22/2009 CLOSED LICENSING CONCERN OF 07/18/07 WITH A CORRECTIVE 1 0 : 3 5 : 0 0 George
ACTION PLAN: The same CAP as the one Hsteo above. Both Stevens
licensing concerns was combined In the CAP submitted by Linda

Tucker-Church.7/18/07 LICENSING CONCERN: Regarding David
and Barbara Frodsham,
Ryan (7), Trevor (5). and Nicholas (3) are
court ward? placed with foster parents David and Barbara
Frodshom.
mm at
, is In the home along with another
grandchild, ||||||||B 7/5/07, o\^rheard
talking. The^noicated that Trevor and Ryan were acting up at a
medical appointment. The foster mother then slapped Trevor on
the face and put itot sauce in his mouth. It is unknown if he was
injured. She then sent both Travor and Ryan to bed that night
without dinner. The foster mother would also pick up Trevor by his
hair before he got it cut. The case manager for the children is
Noeml Ochoa. Her phone number Is 520-432-5652 or 520-432-
4337. Notiflcaiton of licensing concern sent to Carrie Zerafe via
email.
EXHIBIT F
David Frodsham sentencing

order, plea agreement, and
indictment for child
pornography and abuse charges
EXHIBIT G
Randall Bischak Federal and

State Indictments
Case4:16-cr-01004-RM-DTF Document 17 Filed 05/18/16 Page 1 of 5
JLr\UO LODGED
JOHN S.LEONARDO _RECEIVEO_COPY

United States Attorn^
District of Arizona mm\B p i fi i i
Cai^ C. Duêe
Assistant U.S. Attorney
United States Courthouse CLERK us DISTRICT COURT
405 W. Congress Street, Suite 4800 DISTRICT OF ARIZONA
Tucson, Arizona 85701
Telephone: 520-620-7300
Email: carin.durYee@usdoj.gov
Attorneys for Plamtiff
N
I THEUNT
ImSTAJESDS
I TRC
I TCOURT
FOR THE DISTRICT OF ARIZONA ncniicftsi
United States of America, mfil£XM£NT
Plaintifr, Violations:
vs. 18 use and (e)
QProdncnon of CiiUd Pornography)
RANDALL ALEXANDER BISCHAK, Connts 1-3
De^dant.
18 use §§ 2252A(a)©(B) and (b)(2)

ôsseôn
Count 7
of ChUdPomograpiiy)
THE GRAND JURY CHARGES: CR16 -10 0 4 TUG

COCWTONE
I Mjiiitii n coccij IB •jcnrri j t %*i
On or about January 23,2016, in Sierra Vista, in the District of Arizona, the
defendant, RANDALL ALEXANDER BISCHAK, did employ, use, persuade, induce,
entice, and coerce a minor male to engage in sexually explicit conduct for the purpose of
producing a visual depiction of such conduct, to wit: a video identifiled as
*'20160123_193830.mp4'*, which visual dq}iction was intended to be transported in

Case 4:16-cr-01004-RM-DTF Document 17 Filed 05/18/16 Page 2 of 5
1 interstate commerce* was produced using materials that had been mailed, shipped, and
2 transported in interstate commerce, and was transported in int^tate commerce.
^ Ail in violation of Title 18, United States Code, Section 22Sl(a).
On or about February 20,2016, in Sierra Vista, in the District of Arizona, the
defendant, RANDALL ALEXANDER BISCHAK, did employ, use, persuade, induce,
^tice, and coerce a minor male to engage in sexually explicit conduct for the purpose of
producing a visual depiction of such conduc^ to wit: a video identified as "MD-
20i60220-WA0006.mp4**, vdiich visual depiction was intended to be transported in
interstate commerce, was produced using materials that had been mailed, shaped, and
transported in interstate commerce, and was bransported in interstate commerce.
All In violation of Title 18, United States Code, Section 2251(a).
20 On or about March IS, 2016, in Sierra Vista, in the District of Arizona, the
21 defendant, RANDALL ALEXANDER BISCHAK, did employ, use, persuade, induce,
22
entice, and coerce a minor male to engage in sexually e?q)licit conduct for die purpose of
23
2^ producing a visual dqiiction of such conduct, to wit: a video identified as "ad89feSf-

25 4f54-4de8<9c81 -96e242lb2cfi)jnp4^ which visual dqiiction was intended to be
2 6
transported in interstate commerce, was produced using materials that had been mailed,
27
United Stipes cf America v. Bandedl BIsdtak
28 Indlctmmt Page 2qfS
shipped, and transported in interstate commerce^ and was transported in interstate
c o m m e r c e .
All in violation of Title 18, United States Cdde, Section 2251(a).
COUNT FOUR
DISTRIBUTION OF CHILD PORNOGRAPHY
On or about December 8, 2015, in Sierra Vista, in the District of Arizona,
RANDALLALEXANDER BISCHAK, uîng any means or ^cilty of interstate or

foreign commerce, did knowingly distribute child pomography, that is, visual depictions,
theproducto
i nofwhcihn
i vovledtheuseof^nn
i orsengagn
i gn
i sexuayl expcilti conduct,
as defined in Title 18, United States Code, Section 2256(2), and which depicted such
conduct, whidi had been shipped and transported in intestate or foreign commerce by
means of computer, or ofiierwise, including, but not limited to, a video file entitled
•1MG_1014.'*
All in violation of Title 18, United States Code, Sections 2252(aX2) and (bXl)*
DISTRIBUTION OF Cl^D PORNOGRAPHY

On or about February 17, 2016, in Sierra Vista, in the District of Arizona,
RANDALL ALEXANDER BISCHAK, uîng any means or fiicility of interstate or
foreign commerce, did knowingly distributej child pomography. that is, visual dqpictions,
the production of which involved the use of minors engaging in sexually esqsHcit conduct.
United Statts of Amo'tca v. Randall Bischdk

fndicim&ii Page 3 of5
as defined in Title 18, United States Code, Section 2256(2), and which dq[>icted such
conduct, whidi had been shipped and transported in interstate or fiareign commerce by
means of computer, or otherwise, including, but not limited to, the fi>llowing video files:
"VID-20160217-WA0000.mp4" and
"VID-20i602l7-WA0001.mp4**
All in violation of Title 18, United States Code, Sections 2252(aX2) and (bXl).
DmiUBimON OF CHILD PORNOGRAPHY
On or about February 20, 2016, in Sierra Vista, in die District of Arizona,
RANDALL ALEXANDER BISCHAK, using any means or &cility of interstate or
foreign commerce, did knowingly distribute child pornography, that is, visual depictions,
the production of which involved the use of minors engaging in sexually explicit conduct,
as defined in Title 18, United States Code, Section 2256(2), and which deleted such
conduct, which had been shipped and transported in intestate or foreign commerce by
means of computer, or otherwise, including, lût not limited to, the folowing video files:
"VID-20160220-WA00064np4'»
All in violation of Title 18, United States Code, Sections 2252(aX2) and (bXl).
United States cf America v. Randall Blschdt

IntHament Page 4 of 5
POSSESSION OF CHULD PORNOGRAPHY
On or about April 14,2016, in Sierra Vista, in the District of Arizona, RANDALL
ALEXANDER BISCHAK, did knowingly ^possess child pornography, that is, visual
!
depictions, the production of which involveci the use of minors, including pre-pubescent
minors, engaging in sexually explicit conduclt, as defined in Title 18, United States Code,
Section 2256(2), and which deleted such conduct, that had been mailed, shipped and
transported in interstate and foreign commerce by any means, including computer, and
which was produced using materials which had been mailed and shipped and transported
in interstate and foreign commerce; that is, Imowingly possessed on a Samsung CDMA
SM-N910V Galaxy Note 4 (IMS! 3114801|76948232). images of child pornography,

including, but not limited to, the following files:
"102204c0.be4d-4e05-a3b2-8506c70fb2ef.mp4"
"7135edcb-f521.4ee4.b76f-87eca7c69edb.mi^" and
"1750dcc6-996f-4c5a-af93-ef6227f0bbf4.miS"
All in violation of Title 18, United States Code. Sections 2252A(aX5XB) and
(bX2).
A TRUE BILL
U t
iidmg Juror
JOHN S.LEONARDO
United States Attorney
District of Arizona RBDACIEDFOR
tBt
Carin C. Duêe
Assistant U.S. Attorney
May 18,2016
United States cf America v. Randtdl BlscHak

Indictment Page 5 of 5
• • FILED
2016 NOV 17 PM |:l»5
IN THE SUPERIOR COURT OF THE STATE OF ARIZONA „ PA??
CLERK OF SUPERIOR COURT
IN AND FOR THE COUNTY OF COCHISE PI. u a
STATE OF ARIZONA, GRAND JURY NO. 16-_
Plaintiff, CASE NO, CR2016- 0
INDICTMENT
RANDALL ALEXANDER BISCHAK,
Defendant.
The Grand Jurors of the County of Cochise, in the name of the State of Arizona,
and by its authority accuse:
RANDALL ALEXANDER BISCHAK
and charge that in Cochise County:
COUNT 1
From on or about March 6, 2016 through April 14, 2016, RANDALL ALEXANDER
BISCHAK committed sexual exploitation of a minor by knowingly distributing, transporting,
exhibiting, receiving, selling, purchasing, electronically transmitting, possessing or exchanging
any visual depiction in which a minor under the age of fifteen years is engaged in exploitive
exhibition or other sexual conduct, to wit: file name f7ab5dd0-95c3-46a9-8c74-
96d6b6b27adf.mp4, located on his cellular phone, in violation of A.RS. §§ 13-3553A.2, 13-
3551,13-3556,13-3557,13-105,13-701,13-702,13-703, 13r705, and 13-801, a class 2 felony,
punishable pursuant to § 13-705.
C O U N T 2
any visual depiction in which a minor under the age of fiftd^n years is engaged in exploitive
exhibition or other sexual conduct, to wit: file name 6e0ddle4-1223-4e2d-8135-
26a6fb3I28df.mp4, located on his cellular phone, in violatipn of A.RS. §§ 13-3553.A.2, 13-
3551, 13-3556, 13-3557, 13-105, 13-701, 13-702, 13-703, 13^705, and 13-801, a class 2 felony,
C O U N T 3
exhibition or other sexual conduct, to wit: file name 17]7deaa-efla-480e-b8aa-
9ba8e7658c43.mp4, located on his cellular phone, in violation of A.R.S. §§ 13-3553.A.2, 13-
3551, 13-3556, 13-3557, 13-105,13-701, 13-702, I3-703i 13-705, and 13-801, a class 2 felony,
CQVNT4
On and before April 14, 2016, RANDALL AllÊXANDER BISCHAK conunitted
sexual exploitation of a minor by knowingly distributing, transporting, exhibiting, receiving,
selling, purchasing, electronically transmitting, possessing or exchanging any visual depiction in
vdiich a minor under the age of fifteen years is engaged in exploitive exhibition or other sexual
conduct, to wit: file name d7772685-c0d5-462f-a036-3a93kbd50d73.mp4, located on his cellular
phone, in violation of A.R.S. §§ 13-3553.A.2, 13-3551, li-3556, 13-3557, 13-105, 13-701, 13-
702,13-703,13-705, and 13-801, a class 2 felony, punishable pursuant to § 13-705.
C O U N T S
BISCHAK conunitted sexual exploitation of a minor by knowingly distributing, transporting,
exhibiting, receiving, selling, purchasing, electronically tr^mitting, possessing or exchanging
exhibition or other sexual conduct, to wit: file name 97d90027-6226-4aa^9304-
44bb28acdl3d.mp4, located on his cellular phone, in violation of A.R.S. §§ 13-3553.A.2, 13-
3551, 13-3556, 13-3557, 13-105, 13-701, 13-702, 13-703, 13-705, and 13-801, a class 2 felony,
puniâble pursuant to § 13-705.
COUNT
any visual deletion in which a minor under the age of fifteen years is engaged in exploitive
exhibition or other sexual conduct, to wit; file name 959eddd3-b775-4bb0-9053-
bldd8e4c77cc.mp4, located on his cellular phone, in violation of A.R.S. §§ 13-3553.A.2, 13-
3551, 13-3556, 13-3557, 13-105, 13-701,13-702, 13-703, 13-705, and 13-801, a class 2 felony,
DATED this Jl!!! day of November, 2016.

I
COCHISE COUNTY ATTORNEY
Sara V. Ransom Foreperson of tHg/jrand Jury

Deputy County Attorney
Filed on 2/13/2017 3:18:37 PM, Clerk
IN THE SUPERIOR COURT OF THE STATE OF ARIZONA, In and for the County of Cochise
JUDGE: HONORABLE TERRY BANNON, MARY ELLEN DUNLAP, Clerk of the Superior Court
DIVISION: by: (2/I3/20I7 3:18.36 PM). Deputy Clerk
COURT REPORTER:
INTERPRETER: HEARING D AT E : 02/02/2017
«PETITIONERADDRESS_FIRST_NAME» CASE NO: S0200JD201500060

«PETITIONERADDRESS_MIDDLE NAME»
« P E T I T I O N E R A D D R E S S _ L A S T _ N A M E » , M I N U T E E N T R Y: X X X X
Petitioner,
H E A R I N G S TA R T T I M E : 0 9 : 0 0 A M
VS HEARING END TIME: 2/2/2017 9:30:00 AM
«RESPONDENTADDRESS FIRST_NAME»
« R £ S P O N D E N TA D D R £ S S M I D D L E N A M E »
«respondentaddressIlast^name»,
Respondent.
Petitioner Choose an item.

Respondent Choose an item.
This matter came before the Court this date for XXXXXXXXXXX
Page 1 of2
Filed on 2/13/2017 3:18:37 PM, Clerk
Date: 02/02/2017 Case No.: S0200JD201500060

Minute Entry - XXXXX
xc: e-mailed (c) by: XXXX date: XXXX; ramled/disiribuCed by: date:
□ Petitioner: □ Respondent:
□ Clerk's Office/Child Support □ DIV XXX JAA □ Court Administration
□ Other
Page 2 of2
IN THE SUPERIOR COURT OF THE STATE OF ARIZONA, In and for the County of Cochise
JUDGE: TERRY BANNON, MARY ELLEN DUNLAP, Clerk of the Superior Court
DIVISION: DIVISION VI
' by: (2/I3/20I7 3:18 PM) Deputy Clerk
COURT REPORTER:
INTERPRETER: H E A I U N G D AT E : 0 2 / 0 2 / 2 0 1 7
I N T H E M AT T E R O F T H E G U A R D I A N S H I P O F : CASE NO: S0200JD201500060
NAME: XXXXXXXXXXXXXXXXXXXX MINUTE ENTRY: REVIEW HEARING
DOB: XX/XX/XXXX H E A R I N G S TA R T T I M E : 0 9 : 0 0 A M
Minor HEARING END TIME: 2/2/2017 9:30:00 AM
P R E S E N T:
Filed on 2/13/2017 3:18:54 PM, Clerk
xc: e-mailed (c) by: XXXX date: XXXX; mailed/distributed by:

^ Petitioner's Attorney
^ Guardian
^ DIVIIJAA
^ Other
Page 2 of2
S TAT E O F A R I Z O N A Plaintifr WARRANT FOR
ARREST
- v s
CASE NO.
CR201600 ^38
Defendant(s) (First, MI, Last)
TO: ANY AUTHORIZED LAW ENFORCEMENT OFFICER,

YOU ARE COMMANDED to arrest and bring the defendant before this court If this court is unavailable or if
the arrest is made in another county, you shall take the defendant before the nearest or most accessible
Magistrate. The defendant is accused of an offense or violation based on the following document filed with the
court: (List the reason for the warrant - use only one of the following selections per warrant)
I
IS Indictment Q Supervening Indictment Q Information O Complaint Q Probation Violation

□ Order of the Court □ Qjurt Rule violation □ Failure to App^ (criminal) □ Failure to Comply
□ Violation of Promise to Appear
This offense or violation is briefly described as follows:
O f Te n s e Date Statute/Rule & Literal Description Class

03-06>20l6 -04-l4>2016 A.R.S. 13-3SS3 Sexual Exploitation of Minor (6 counts) F2
IS The defendant may be released if a S230.000J.00 (secured appearance) (cash) bond is posted by or on
behalf of the accused.
□ The defendant shall be held WITHOUT BOND.
The offense is, or is materially related to, a victims' rights applicable offgnssL.^ .,
Judicial Officei/Clerk of Superior Court
EXTRADITION: ACIC
PURGE DATE:
L E A G E N C Y : S i e r r a V i s t a P. D . C I T A T I O N # : DRil: 16-14197
CERTF
IC
I ATEOFEXECUTC
IN
I
I certify that die defendant was arrested at â.m7p.m. on L 20__.
(ir
(month) (day) (year)
and presented defendant before Judge at j_
Agency
Deputy SherifRÔfFicer Badge#

Filed on 2/13/2017 3:19:06 PM, Clerk
S U P E R I O R C O U RT, S I'ATE OF ARIZONA, In and for the County of Cochise
XXXXXXXXXXXX,
Plaintiff, Case No.
« D E F E N D A N TA D D R E S S C A
vs. SE_NUMBER»
« D E F E N D A N TA D D R E S S F I R S T ORDER AMENDING
NAME»«DEFENDANTADDRE MINUTE ENTRY
SS MIDDLE NAME»«DEFEND FROM COURT HEARING
ANTADDRESS_LAST_NAME» D AT E :
XXXXXXj
Defendant.
HONORABLE TERRY BANNON, M A R Y E L L E N D lJNLAP, Clerk

DIVISION XXXX By: (XX/Wxx) Deputy
Dated this xx day of xxxxxx, 201 x.

BONDS: KEFKNonmrenviiB COUNTY OF COCHISE !
R N E S AT I Y. F E S a £ S T T T V n O N
Date November 17,2016

II ATr a » ( E V: A » P T * C U t M S
II SUmST
II DtVtStON
II MAOEO
S TAT E O F A R I Z O N A , P l a i n t i f T v s . R A N D A L L A L E X A N D E R B I S C H A K , D e f e n d a n t
i DOB: (01/05/1991)
MINUTE ENTRY ACTION: GRAND JURY INDICTMENT 1 CASE NO: CR201600938
JUDGE HONORABLE JAMES L CONLOGUE M A RY E L L E N D U N L A P, C L E R K

DWiSION Five By: Chelsea DeBee. Deputy aerfc (1M7-I6)
COURT REPORTER Van G. Honeman Docketed bv
ADDRESS & PHONE
PRESENT: State present: Sara Ransom, Deputy County Attorney, and Grand Jurors;
THE RECORD MAY SHOW the Grand Jury returned an Indictment against RANDALL
ALEXANDER BISCHAK, bearing Grand Jury No. GJ16>0290 vhich the Court assigned Superior Court Case
No. CR201600938 for STATE OF ARIZONA -vs- RANDALL ALEXANDER BISCHAK, assigned to
Division THREE of this court.
IT IS ORDERED that a Grand Jury warrant be issued A.C.i.C. for the arrest of the Defendant.
Defendant shall be held on Two Hundred Fifty Thousand ($250,000.00) Dollars Bond, cash or secured,
pending further order of the Court. Upon apprehension, the defendant shall be brought before the Honorable,
James L. Conlogue for arraignment purposes onfy.
xc: County Attorney

IDC
Va n G . H o n e m a n
Grand Jury master file
CCSO/Wanants (Certified)
EXHIBIT H
Anthony Savage Indictment

EXHIBIT I
New York Times - Afghan

Pedophiles Get Free Pass From
U.S. Military, Report Says
Afghan Pedophiles Get Free Pass From U.S. Military, Report Says - The New York Times 10#59 AM,1/29/18,1/29/18, 10#59 AM
https://nyti.ms/2GcpggL
ASIA PACIFIC
Afghan Pedophiles Get Free Pass From

U.S. Military, Report Says
By ROD NORDLAND JAN. 23, 2018
On 5,753 occasions from 2010 to 2016, the United States military asked to review
Afghan military units to see if there were any instances of “gross human rights
abuses.” If there were, American law required military aid to be cut off to the
offending unit.
Not once did that happen.
That was among the findings in an investigation into child sexual abuse by the
Afghan security forces and the supposed indifference of the American military to
the problem, according to a report released on Monday by the Special Inspector
General for Afghan Reconstruction, known as Sigar.
The report, commissioned under the Obama administration, was considered

so explosive that it was originally marked “Secret/No Foreign,” with the
recommendation that it remain classified until June 9, 2042. The report was
finished in June 2017, but it appears to have included data only through 2016,
before the Trump administration took office.
The report released on Monday was heavily redacted, and at least in the public
https://www.nytimes.com/2018/01/23/world/asia/afghanistan-military-abuse.html Page 1 of 4
portions it did little to answer questions about how prevalent child sexual abuse
was in the Afghan military and police, and how commonly the American military
looked the other way at the widespread practice of bacha bazi, or “boy play,” in
which some Afghan commanders keep underage boys as sex slaves.
“Although DOD and State have taken steps to identify and investigate child
sexual assault incidents, the full extent of these incidences may never be known,”
the report said, referring to the departments of Defense and State.
Sigar said it had opened an investigation into bacha bazi at the request of Congress
and in response to a 2015 New York Times article that described the practice as
“rampant.” The article said that American soldiers who complained had their
careers ruined by their superiors, who had encouraged them to ignore the practice.
“DOD and State only began efforts to address this issue after it was raised by
The New York Times,” said John F. Sopko, the special inspector general. “And even
after that story, the sufficiency of policies they’ve put in place and the resources
they’ve committed seem questionable. When Congress passed the Leahy laws they
prioritized the issue of gross human rights violations. As our report clearly shows,
both agencies failed to live up to that task.”
A former Special Forces officer, Capt. Dan Quinn, who beat up an Afghan
commander for keeping a boy chained to his bed as a sex slave, said at the time
that he had been relieved of his command as a result. “We were putting people into
power who would do things that were worse than the Taliban did,” said Captain
Quinn, who has left the military.
Sgt. First Class Charles Martland, a highly decorated Green Beret, was forced
out of the military after beating up an Afghan local police commander in Kunduz
who was a child rapist. Sergeant Martland became incensed after the Afghan
commander abducted the boy, raped him, then beat up the boy’s mother when she
tried to rescue him. Congressional inquiries apparently led to Sergeant Martland’s
reinstatement.
The Times article also cited the suspicious death of Lance Cpl. Gregory
Buckley Jr., a United States Marine who was killed at a checkpoint where he was
stationed with a notorious commander who had a retinue of bacha bazi boys.
Corporal Buckley had complained about that commander and was killed, along
with two other Marines, by one of the commander’s boys.
The Sigar report made no mention of the cases of Corporal Buckley, Captain
Quinn or Sergeant Martland, and it appeared to have interviewed only three
unnamed American soldiers who reported being aware of the practice, which many
soldiers and Afghan officials have told journalists they know to be widespread.
As of Aug. 12, 2016, the Defense Department was investigating 75 instances of

gross human rights violations, seven involving child sexual assault, but even
Defense Department officials acknowledged that that was a small portion of the
total, the Sigar report said.
Under the Leahy Law, United States military aid funds must be cut off to any
foreign military unit implicated in gross human rights violations, which includes
the practice of bacha bazi, with its enslavement and rape of young boys. But
another provision of American law, called the “notwithstanding clause,” says that
Afghan military aid should be available “notwithstanding any other provision of
law.”
The Sigar report said that the “notwithstanding clause” had been used
repeatedly to evade cutting off military aid to Afghan units.
“DOD’s continuing to provide assistance to units for which the department has
credible information of a gross violation of human rights undermines efforts by
U.S. government officials to engage with the Afghan government on the
importance of respect for human rights and rule of law,” the report said. But it also
said no evidence had been found that American soldiers were ordered to look the
other way as a matter of policy, or that their commanders condoned the bacha bazi
practice.
American military commanders in Afghanistan have repeatedly denied that

there was any policy to condone child sexual abuse.
The Sigar report recommended restricting the use of that “notwithstanding

clause” to evade the provisions of the Leahy Law, and a draft defense
appropriations bill supports that recommendation.
The practice is so widespread that at least one of the 2014 Afghan presidential
candidates was a onetime C.I.A.-backed warlord, Gul Agha Shirzai, who was widely
accused of being a pedophile who keeps bacha bazi boys.
President Ashraf Ghani vowed to end the practice in a 2015 speech, but there
have been few, if any, prosecutions by the Afghan authorities for bacha bazi
practices. Mr. Shirzai is now the minister of border and tribal affairs in Mr. Ghani’s
government.
Correction: January 26, 2018

An earlier version of this article referred incorrectly to 5,753 cases from 2010 to 2016
involving the United States and Afghan militaries. Those were cases in which the
American military asked to review Afghan units to see if there were “gross human rights
abuses,” not the number of times the American military reported such abuses.
Follow Rod Nordland on Twitter: @rodnordland
A version of this article appears in print on January 24, 2018, on Page A10 of the New York edition with the
headline: Afghan Pedophiles Get Pass From U.S. Military, Report Says.
© 2018 The New York Times Company

Arizona Foster Care Lawsuit John Doe Notice of Claim 2018-01-31

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CADIGAN LAW FIRM, PLLC

A Professional Limited Liability Company

January 31, 2018

NOTICE OF CLAIM UNDER A.R.S. §. 12-821.01

SERVED BY PRIVATE PROCESS SERVER & SENT BY CERTIFIED MAIL

504 South Stone Avenue, Tucson, Arizona 85701

State of Arizona Employees/DCS/CPS including the following:

Jane and John Does 1-15

Re: Notice of Claim by John Doe1

I. FACTS PROVIDING BASIS FOR CLAIMS

“I recommend the unit keep Mr. Frodsham resigned out of BSG

I recommend making this misconduct a official matter of record and take

II. LAW SUPPORTING CLAIMS

Class action lawsuit against

1 Joseph Mais (005470) William Kapell (admitted pro hac vice)

1 THIRD CAUSE OF ACTION – VIOLATION OF PLAINTIFFS’ SUBSTANTIVE

5 in his official capacity.

6 Members of the General Class Are Not Receiving Timely Investigations of

14 enormous backlogs, DCS’s failure to complete child maltreatment investigations in a

19 involving children in state foster custody.

25 were initiated late.

1 b. Attorneys employed by the Arizona Center for Law in the Public

12 family reunification (the “Reunification Subclass”).

24 interfering with their ability to maintain connections with their families.

1 c. Attorneys employed by Children’s Rights, Inc., a nonprofit legal

1 D. Permanently enjoin DCS, DHS and AHCCCS from subjecting plaintiffs to

1 514 West Roosevelt Street

New York Times - Gov. Jan

Gov. Jan Brewer of Arizona Overhauls

PHOENIX — Gov. Jan Brewer abolished Arizona’s beleaguered Child Protective

The change requires legislative approval, but it is unlikely to face significant

Charles Flanagan, director of the Arizona Department of Juvenile Corrections, will

© 2018 The New York Times Company

In Harm’s Way: A Report on

ARIZONA VOICE FOR CRIME VICTIMS

Shawn Cox, MSW

March 15, 2003

Chapter Five: Voices from the Field:

INTRODUCTION: SCOPE OF STUDY, METHODOLOGY, AND DEFINITONS

2) Current role and issues with the child welfare system

Defining Abuse and Neglect

and policy planning.”[5]

maltreatment of a child by any person.”[10]

CHAPTER ONE: FIRST PRINCIPLES

Governments are instituted among Men… .”[16]

sooner in the life of a criminally abused or neglected child.[25]

CHAPTER TWO: NATIONAL HISTORICAL OVERVIEW

State Governments, the American Medical Association, and the American

knowing how to make a report under it.[44]

reports exceeded 1 million.[46]

500,000 children were in foster care.”[48]

child abuse and neglect prevention efforts.[52]

continued foster care rather than reunification.[55]

significant legislation in the history of child welfare.[57]

implement permanency planning for foster children. [Fn. omitted].”[58]

and 8% were psychologically maltreated.

Oct. 1, 1999 – March 31, 2000 16,301 1.524 9.3

CHAPTER FOUR: CURRENT LAW

procedural protections than do those resisting state intervention into ongoing

description of this right is found in Michael M. v. Arizona Department of Economic Security:[79]

procedures. In Arizona, "[t]ermination of parental rights is **685 *249

in the case of a parent whose mental disability prohibits proper parenting.[81]

before petitioning for severance...

In the absence of such a [nurturing] parental relationship, a biological parent's